Healthcare Provider Details

I. General information

NPI: 1609329275
Provider Name (Legal Business Name): AARON KIRKWOOD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2016
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 BIG BEAR RD
BOGART GA
30622-5135
US

IV. Provider business mailing address

830 BIG BEAR RD
BOGART GA
30622-5135
US

V. Phone/Fax

Practice location:
  • Phone: 470-896-1331
  • Fax:
Mailing address:
  • Phone: 470-896-1331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: