Provider Demographics
NPI:1922129105
Name:DAVID T. KIRK AND ASSOCIATES
Entity Type:Organization
Organization Name:DAVID T. KIRK AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-678-2323
Mailing Address - Street 1:206 HOSPITAL DR.
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30673
Mailing Address - Country:US
Mailing Address - Phone:706-678-2323
Mailing Address - Fax:706-678-4437
Practice Address - Street 1:206 HOSPITAL DR.
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:GA
Practice Address - Zip Code:30673
Practice Address - Country:US
Practice Address - Phone:706-678-2323
Practice Address - Fax:706-678-4437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GRP4981Medicare PIN