Healthcare Provider Details

I. General information

NPI: 1588570121
Provider Name (Legal Business Name): JAMES KIRKLAND CNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3674 DEANS BRIDGE RD APT 3
HEPHZIBAH GA
30815-4114
US

IV. Provider business mailing address

3674 DEANS BRIDGE RD APT 3
HEPHZIBAH GA
30815-4114
US

V. Phone/Fax

Practice location:
  • Phone: 706-360-6171
  • Fax:
Mailing address:
  • Phone: 706-360-6171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCN0030096897
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: