Healthcare Provider Details

I. General information

NPI: 1477180107
Provider Name (Legal Business Name): DR. MARK KIRK JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4370 W MAIN ST
DOTHAN AL
36305-1056
US

IV. Provider business mailing address

PO BOX 680060
FRANKLIN TN
37068-0060
US

V. Phone/Fax

Practice location:
  • Phone: 334-793-5000
  • Fax: 659-235-6176
Mailing address:
  • Phone: 877-848-1457
  • Fax: 629-235-6703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number70907
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: