1952319642 NPI number — PHOEBE PUTNEY MEMORIAL HOSPTIAL, INC.

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 1952319642 NPI number — PHOEBE PUTNEY MEMORIAL HOSPTIAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHOEBE PUTNEY MEMORIAL HOSPTIAL, INC.
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:
6
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:
1952319642
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1828
Provider Second Line Business Mailing Address:
417 W. 3RD AVENUE
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31702-1828
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-312-6761
Provider Business Mailing Address Fax Number:
229-312-6705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2709 MEREDYTH DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31707-0222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-312-9651
Provider Business Practice Location Address Fax Number:
229-312-9655
Provider Enumeration Date:
08/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARTER
Authorized Official First Name:
MARTHA
Authorized Official Middle Name:
GAIL
Authorized Official Title or Position:
VP, REVENUE CYCLE
Authorized Official Telephone Number:
229-312-6704

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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