# ALTAMAHA PRIMARY CARE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093472896
- **Authorized official:** MRS. KIMBERLY KIRK AGACNP, RN (OWNER/PRESIDENT)
- **Authorized official phone:** (912) 559-2420

## Contact information

- **Practice address:** 248 NE BROAD ST, JESUP, GA 31546-4371
- **Practice address phone:** (912) 559-2696
- **Practice address fax:** (912) 559-2420
- **Mailing address:** 248 NE BROAD ST, JESUP, GA 31546-4371
- **Mailing address phone:** (912) 559-2696
- **Mailing address fax:** (912) 559-2420

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | Yes |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 11/29/2021
- **Last updated:** 11/29/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | G07348B | — | GA |