Provider Demographics
NPI:1922280700
Name:AFFILIATED MEDICAL GROUP, PLLC
Entity Type:Organization
Organization Name:AFFILIATED MEDICAL GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:AHLBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-939-0724
Mailing Address - Street 1:PO BOX 12459
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-2459
Mailing Address - Country:US
Mailing Address - Phone:910-939-0724
Mailing Address - Fax:910-333-9145
Practice Address - Street 1:39 OFFICE PARK DR STE A
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-3220
Practice Address - Country:US
Practice Address - Phone:910-939-0724
Practice Address - Fax:910-333-9145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5908381Medicaid