Healthcare Provider Details

I. General information

NPI: 1386675817
Provider Name (Legal Business Name): EARLY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11168 COLUMBIA ST SUITE B
BLAKELY GA
39823-3474
US

IV. Provider business mailing address

920 CAIRO RD
THOMASVILLE GA
31792-4255
US

V. Phone/Fax

Practice location:
  • Phone: 229-723-4313
  • Fax: 229-723-3734
Mailing address:
  • Phone: 229-227-5500
  • Fax: 229-227-5505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number4945
License Number StateGA

VIII. Authorized Official

Name: MR. CHARLES D HIGHTOWER JR.
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 229-228-2853