1780010686 NPI number — CHARLIE NORWOOD VA MEDICAL CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780010686 NPI number — CHARLIE NORWOOD VA MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLIE NORWOOD VA MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780010686
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 FREEDOM WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30904-6258
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-733-0188
Provider Business Mailing Address Fax Number:
706-481-6703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 FREEDOM WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30904-6258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-733-0188
Provider Business Practice Location Address Fax Number:
706-481-6703
Provider Enumeration Date:
09/24/2013

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMSADAMS
Authorized Official First Name:
LILLIE
Authorized Official Middle Name:
MAE
Authorized Official Title or Position:
BLIND REHABILITATION SPECIALIST
Authorized Official Telephone Number:
706-733-0188

Provider Taxonomy Codes

  • Taxonomy code: 282E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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