Healthcare Provider Details

I. General information

NPI: 1922280700
Provider Name (Legal Business Name): AFFILIATED MEDICAL GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 OFFICE PARK DR STE A
JACKSONVILLE NC
28546-3220
US

IV. Provider business mailing address

PO BOX 12459
JACKSONVILLE NC
28546-2459
US

V. Phone/Fax

Practice location:
  • Phone: 910-939-0724
  • Fax: 910-333-9145
Mailing address:
  • Phone: 910-939-0724
  • Fax: 910-333-9145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID JOSEPH AHLBERG
Title or Position: OWNER
Credential: MD
Phone: 910-939-0724