Healthcare Provider Details

I. General information

NPI: 1851356349
Provider Name (Legal Business Name): PHOEBE PUTNEY MEMORIAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 FOUNDATION LN
ALBANY GA
31707-5862
US

IV. Provider business mailing address

320 FOUNDATION LN
ALBANY GA
31707-5862
US

V. Phone/Fax

Practice location:
  • Phone: 229-312-7050
  • Fax: 229-312-7055
Mailing address:
  • Phone: 229-312-7050
  • Fax: 229-312-7055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State

VIII. Authorized Official

Name: BRIAN ALLEN CHURCH
Title or Position: CFO
Credential:
Phone: 229-312-4068