Healthcare Provider Details

I. General information

NPI: 1336446855
Provider Name (Legal Business Name): AMY L ZIRKLE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2011
Last Update Date: 02/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 FANT DR
FT OGLETHORPE GA
30742-3307
US

IV. Provider business mailing address

1875 FANT DR
FT OGLETHORPE GA
30742-3307
US

V. Phone/Fax

Practice location:
  • Phone: 706-861-3387
  • Fax:
Mailing address:
  • Phone: 706-861-3387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMSW005310
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: