Healthcare Provider Details

I. General information

NPI: 1467652107
Provider Name (Legal Business Name): GRADY GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 04/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 5TH ST SE
CAIRO GA
39828-3142
US

IV. Provider business mailing address

1155 5TH ST SE
CAIRO GA
39828-3142
US

V. Phone/Fax

Practice location:
  • Phone: 229-377-1150
  • Fax:
Mailing address:
  • Phone: 229-377-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHRE007998
License Number StateGA

VIII. Authorized Official

Name: GREG HEMBREE
Title or Position: SENIOR VP/CFO
Credential:
Phone: 229-228-2853