Basic Information
| Provider Information | |||||||||
| NPI: | 1598754962 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AUSTIN | ||||||||
| FirstName: | KIRK | ||||||||
| MiddleName: | OLEN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 104 CEDAR CREEK DR | ||||||||
| Address2: | |||||||||
| City: | DUBLIN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310214200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4782969044 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 INDUSTRIAL BLVD | ||||||||
| Address2: | |||||||||
| City: | DUBLIN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310212981 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4782752000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 037471 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.