Provider Demographics
NPI:1235361015
Name:MUNSAYAC, KIRK ALESSANDRO (DO)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:ALESSANDRO
Last Name:MUNSAYAC
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CROSS ST
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:GA
Mailing Address - Zip Code:31539-6426
Mailing Address - Country:US
Mailing Address - Phone:912-375-4884
Mailing Address - Fax:912-375-4881
Practice Address - Street 1:22 CROSS STREET
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:GA
Practice Address - Zip Code:31539
Practice Address - Country:US
Practice Address - Phone:912-375-4884
Practice Address - Fax:912-375-4881
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA068251207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003127064FMedicaid