Healthcare Provider Details

I. General information

NPI: 1750373023
Provider Name (Legal Business Name): KIRPICH JOSEPH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 10/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 PLEASANT HILL RD NW STE 104
LILBURN GA
30047-2770
US

IV. Provider business mailing address

449 PLEASANT HILL RD NW STE 104
LILBURN GA
30047-2770
US

V. Phone/Fax

Practice location:
  • Phone: 678-475-1400
  • Fax: 678-475-1030
Mailing address:
  • Phone: 678-475-1400
  • Fax: 678-475-1030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number054904
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: