Altamaha Primary Care, LLC

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

Legal business name

ALTAMAHA PRIMARY CARE, LLC

Practice address

248 NE Broad St
Jesup, GA 31546-4371

Phone

(912) 559-2696

Fax

(912) 559-2420

NPI assigned

Nov 29, 2021

Organization subpart

No

Name

Mrs. Kimberly Kirk, AGACNP, RNNPI 1063992808

Title

Owner/President

Phone

(912) 559-2420

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kimberly Ann Kirk, AGACNP

  • Acute Care Nurse Practitioner
  • Brunswick, GA
  • NPI 1063992808

  GA

  Medicare reassignment NPD Authorized official

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 29, 2021.

{
    "created_epoch": "1638144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638144000000",
    "number": "1093472896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "248 NE BROAD ST",
            "city": "JESUP",
            "state": "GA",
            "postal_code": "315464371",
            "telephone_number": "912-559-2696",
            "fax_number": "912-559-2420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "248 NE BROAD ST",
            "city": "JESUP",
            "state": "GA",
            "postal_code": "315464371",
            "telephone_number": "912-559-2696",
            "fax_number": "912-559-2420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTAMAHA PRIMARY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-29",
        "last_updated": "2021-11-29",
        "certification_date": "2021-11-29",
        "status": "A",
        "authorized_official_last_name": "KIRK",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "912-559-2420",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "AGACNP, RN"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G07348B",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "www.altamahacare.com",
            "affiliation": "N",
            "address_1": "248 NE Broad St",
            "city": "Jesup",
            "state": "GA",
            "country_code": "US",
            "postal_code": "315464371",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Thomas Michael Amburgey, M.D.
• American Eyecare Center of Jesup Inc
• Anchored in Wellness, LLC
• Myron Stuart Anderson, PHARMD

• All providers in Jesup, GA
• Primary Care Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.