Provider Demographics
NPI:1376068064
Name:MUNSAYAC HEALTH LLC
Entity Type:Organization
Organization Name:MUNSAYAC HEALTH LLC
Other - Org Name:MUNSAYAC HEALTH LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:ALESSANDRO
Authorized Official - Last Name:MUNSAYAC
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:912-375-4884
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 ST
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:GA
Practice Address - Zip Code:31539-6426
Practice Address - Country:US
Practice Address - Phone:912-375-4884
Practice Address - Fax:912-375-4881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA68251207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPENDINGMedicaid