Healthcare Provider Details

I. General information

NPI: 1821394271
Provider Name (Legal Business Name): PHOEBE SENIOR CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2011
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 E BROAD ST
CAMILLA GA
31730-1865
US

IV. Provider business mailing address

161 E BROAD ST
CAMILLA GA
31730-1865
US

V. Phone/Fax

Practice location:
  • Phone: 229-336-5208
  • Fax: 229-336-8260
Mailing address:
  • Phone: 229-336-5208
  • Fax: 229-336-8260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT LAGESSE
Title or Position: SR VP PHYSICIAN PRACTICES
Credential:
Phone: 229-312-1000