Healthcare Provider Details

I. General information

NPI: 1083816128
Provider Name (Legal Business Name): THE KIRK CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 LAUREL CT
MOULTRIE GA
31768-6889
US

IV. Provider business mailing address

PO BOX 3877
MOULTRIE GA
31776-3877
US

V. Phone/Fax

Practice location:
  • Phone: 229-891-9016
  • Fax: 229-891-9185
Mailing address:
  • Phone: 229-891-9016
  • Fax: 229-891-9185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL

VIII. Authorized Official

Name: JAMES L MATNEY
Title or Position: CEO
Credential:
Phone: 229-985-3420