| Affiliated Medical Group, Pllc | |
|
39 Office Park Dr Ste A Jacksonville NC 28546-3220 | |
| (910) 939-0724 | |
| (910) 333-9145 |
| Full Name | Affiliated Medical Group, Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 39 Office Park Dr Ste A, Jacksonville, North Carolina |
| Authorized Official Name and Position | David Joseph Ahlberg (OWNER) |
| Authorized Official Contact | 9109390724 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Affiliated Medical Group, Pllc Po Box 12459 Jacksonville NC 28546-2459 Ph: (910) 939-0724 | Affiliated Medical Group, Pllc 39 Office Park Dr Ste A Jacksonville NC 28546-3220 Ph: (910) 939-0724 |
| NPI Number | 1922280700 |
|---|---|
| Provider Enumeration Date | 12/03/2007 |
| Last Update Date | 10/17/2023 |
| Certification Date | 10/17/2023 |
| Medicare PECOS PAC ID | 2860575610 |
|---|---|
| Medicare Enrollment ID | O20080216000103 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922280700 | NPI | - | NPPES |
| 5908381 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Secondary |
| Provider Name | David Ahlberg |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1679519706 PECOS PAC ID: 6608874862 Enrollment ID: I20061122000173 |
| Provider Name | Debra L Livingston-green |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164724688 PECOS PAC ID: 8325227275 Enrollment ID: I20110124001022 |
| Provider Name | Jessica Burke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952929598 PECOS PAC ID: 5597182022 Enrollment ID: I20200829000133 |
| Provider Name | Alfredo Ernesto Baker |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407823420 PECOS PAC ID: 6002209566 Enrollment ID: I20220204000185 |
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