MEDICARE: HEIDI E KIRK-SENIOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1497604318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI E KIRK-SENIOR

Provider Business Mailing Address
First Line	:	3791 DEATON TRL
Second Line	:
City	:	BUFORD
State	:	GA
Zip	:	30519-1111
Country	:	US
Telephone Number	:	706-572-7400
Fax Number	:

Provider Business Practice Location Address
First Line	:	3791 DEATON TRL
Second Line	:
City	:	BUFORD
State	:	GA
Zip	:	30519-1111
Country	:	US
Telephone Number	:	706-572-7400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2026
Last Update Date	:	01/23/2026

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