Individual
JUSTIN KIRKPATRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
1107 MEMORIAL DR STE 200, DALTON, GA 30720-8662
(706) 226-9355
(706) 226-9380
Mailing address
PO BOX 1587, DALTON, GA 30722-1587
(706) 529-7440
(706) 529-7437
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
203897
GA
363LF0000X
Family Nurse Practitioner
RN203897
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003152163B
—
GA
01
—
02548977
AMERIGROUP
GA
01
—
1028420
WELLCARE
GA
Enumeration date
05/28/2014
Last updated
02/10/2016
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