Provider Demographics
NPI:1447688262
Name:TOWN CENTRAL INSURANCE
Entity type:Organization
Organization Name:TOWN CENTRAL INSURANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:PHAILOTH
Authorized Official - Middle Name:
Authorized Official - Last Name:LOONUBON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-778-6268
Mailing Address - Street 1:748 STONECYPHER ST
Mailing Address - Street 2:
Mailing Address - City:CORNELIA
Mailing Address - State:GA
Mailing Address - Zip Code:30531-2456
Mailing Address - Country:US
Mailing Address - Phone:706-778-6268
Mailing Address - Fax:706-778-6271
Practice Address - Street 1:748 STONECYPHER ST
Practice Address - Street 2:
Practice Address - City:CORNELIA
Practice Address - State:GA
Practice Address - Zip Code:30531-2456
Practice Address - Country:US
Practice Address - Phone:706-778-6268
Practice Address - Fax:706-778-6271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA15985727251X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage