Healthcare Provider Details

I. General information

NPI: 1114134772
Provider Name (Legal Business Name): CRISP REGIONAL HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4110 BEDGOOD AVE
ARABI GA
31712-3669
US

IV. Provider business mailing address

4110 BEDGOOD AVE
ARABI GA
31712-3669
US

V. Phone/Fax

Practice location:
  • Phone: 229-273-0116
  • Fax: 229-273-4853
Mailing address:
  • Phone: 229-273-0116
  • Fax: 229-273-4853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateGA

VIII. Authorized Official

Name: CHARLOTTE VESTAL
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 229-276-3100