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General NPI Number Information
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NPI Number | 1083816128
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Entity Type | Organization
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Legal Business Name | THE KIRK CLINIC LLC
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 8 LAUREL CT
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City | MOULTRIE
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State | GA
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Zip | 31768-6889
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Country | US
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Telephone | 229-891-9016
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Fax | 229-891-9185
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Provider Business Mailing Address
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Address Line | PO BOX 3877
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City | MOULTRIE
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State | GA
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Zip | 31776-3877
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Country | US
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Telephone | 229-891-9016
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Fax | 229-891-9185
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Authorized Official
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Title or Position | CEO
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Name | JAMES L MATNEY
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Credential |
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Telephone | 229-985-3420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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