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General NPI Number Information
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NPI Number | 1699423889
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Entity Type | Organization
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Legal Business Name | KIRK CONSTANT CARE LLC
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Dates
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Enumeration Date | 03/16/2022
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Last Update Date | 07/28/2023
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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 |
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Provider Business Mailing Address
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Address Line | PO BOX 2876
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City | MOULTRIE
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State | GA
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Zip | 31776-2876
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Country | US
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Telephone | 229-891-9131
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | STEWART MERDIAN
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Credential |
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Telephone | 229-890-3531
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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