ALTAMAHA PRIMARY CARE LLC NPI 1093472896

NPI Information

NPI: 1093472896
Provider Name: ALTAMAHA PRIMARY CARE, LLC
Classification: Nurse Practitioner - 363LP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 11D2247531

Address:
248 NE BROAD ST
JESUP, GA
ZIP 31546
Phone: (912) 559-2696
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ALTAMAHA PRIMARY CARE, LLC is a primary care nurse practitioner in Jesup, GA. ALTAMAHA PRIMARY CARE, LLC NPI is 1093472896. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

248 NE BROAD ST
JESUP, GA
ZIP 31546-371
Phone: (912) 559-2696
Fax: (912) 559-2420

The provider's authorized official is Kimberly Kirk .
The authorized official title is Owner/president and has the following contact phone number (912) 559-2420.

The CLIA number assigned to this NPI record is 11D2247531 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/29/2021 and was last updated on 11/29/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LP2300X	Nurse Practitioner	Primary Care			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	G07348B	MEDICAID	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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