1811397060 NPI number — IRWIN COUNTY HOSPITAL

Table of content: DR. ASHLEY NICOLE HOLLAND PHARM.D. (NPI 1881220457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811397060 NPI number — IRWIN COUNTY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IRWIN COUNTY HOSPITAL
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:
WOMENS CENTER OF CYPRESS POND
Provider Other Organization Name Type Code:
3
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:
1811397060
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
710 N IRWIN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCILLA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31774-5011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-468-3800
Provider Business Mailing Address Fax Number:
229-468-9991

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
72 KENT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TIFTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31794-1694
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-396-5873
Provider Business Practice Location Address Fax Number:
229-396-5876
Provider Enumeration Date:
08/25/2014

Additional Information

Authorized Official

Authorized Official Last Name:
GRIFFIN
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF FINANCIAL SERVICES
Authorized Official Telephone Number:
229-468-3862

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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