MEDICARE: PHOEBE PUTNEY MEMORIAL HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1316060585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOEBE PUTNEY MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	PO BOX 2548
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31702-2548
Country	:	US
Telephone Number	:	229-312-5870
Fax Number	:	229-312-5853

Provider Business Practice Location Address
First Line	:	2410 SYLVESTER RD
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31705-2479
Country	:	US
Telephone Number	:	229-312-9200
Fax Number	:	229-312-9205

Authorized Official
Title or Position	:	DIRECTOR OF PHYSICIAN SERVICES
Name	:	FRANK F MIDDLETON III
Credential	:	MD
Telephone Number	:	229-312-4055

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	08/22/2020

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