1760436323 NPI number — DOCTORS HOSPITAL COLUMBUS GA - JOINT VENTURE

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760436323 NPI number — DOCTORS HOSPITAL COLUMBUS GA - JOINT VENTURE

Employer Identification Number (EIN):

Provider Organization Name:

DOCTORS HOSPITAL COLUMBUS GA - JOINT VENTURE

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

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:

1760436323

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

08/22/2020

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 2188

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

COLUMBUS

Provider Business Mailing Address State Name:

GA

Provider Business Mailing Address Postal Code:

31902-2188

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

706-494-4262

Provider Business Mailing Address Fax Number:

706-494-4156

Provider First Line Business Practice Location Address:

616 19TH ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

COLUMBUS

Provider Business Practice Location Address State Name:

GA

Provider Business Practice Location Address Postal Code:

31901-1528

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

706-494-4262

Provider Business Practice Location Address Fax Number:

706-494-4156

Provider Enumeration Date:

05/19/2006

Authorized Official Last Name:

SALLER

Authorized Official First Name:

BILL

Authorized Official Middle Name:

Authorized Official Title or Position:

CFO

Authorized Official Telephone Number:

706-494-4381

• Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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