Healthcare Provider Details

I. General information

NPI: 1609820661
Provider Name (Legal Business Name): COLUMBIA POLK GENERAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 N MAIN ST
CEDARTOWN GA
30125-2644
US

IV. Provider business mailing address

424 N MAIN ST
CEDARTOWN GA
30125-2644
US

V. Phone/Fax

Practice location:
  • Phone: 770-748-2500
  • Fax: 770-749-9904
Mailing address:
  • Phone: 770-748-2500
  • Fax: 770-749-9904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: TIM PRESTRIDGE
Title or Position: CFO
Credential:
Phone: 770-748-8506