DEPARTMENT OF INSURANCE

Name	Chanthavisouk, Cinthia Colon	DOIID	1162656	NAIC NPN	19724308

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date	Designated Home State
Active	Non Resident	Agent	Health	9/29/2021		6/30/2025

*If a status is Pending, Pending Replacement,or the record displays Affidavit on File, click on them for more details.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	04/15/2025	06/30/2025

NOTE: Licensee may renew up to 6 months prior to Next Compliance Date. Licensees subject to CE must complete CE requirements before Next Compliance Date in order to successfully complete the License Renewal Process.

Address Information

Type	Address
Business / Home Office	715 Burnett Ferry Rd Sw Rome, GA 301653657
Residence	Not Public Information

Internet Information

Type	Address
Business Email	cinthia.chanthavisouk@gmail.com

Phone Information

Type	Phone
Business / Home Office	(706) 572-8341