National Provider Identifier Database

ALTAMAHA PRIMARY CARE LLC
Primary Care


Contact Information

ALTAMAHA PRIMARY CARE, LLC
248 NE BROAD ST
JESUP, GA31546-4371
Phone: 912-559-2696
Fax: 912-559-2420
Website:
Specialty Taxonomy Code
* Primary Care 363LP2300X

* Indicates primary specialty

NPI Profile & details for ALTAMAHA PRIMARY CARE, LLC

NPI Number 1093472896
Legal business name
LBN
ALTAMAHA PRIMARY CARE, LLC
Authorized official KIMBERLY KIRK - (OWNER/PRESIDENT)
Entity Organization
Organization subpart No
Enumeration date 11/29/2021
Last updated 11/29/2021 - About 5 years ago
Sole proprietor1 Not specified
Identifiers
  • GA Medicaid: G07348B

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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