Healthcare Provider Details

I. General information

NPI: 1801920483
Provider Name (Legal Business Name): WEST CENTRAL GEORGIA REGIONAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 SCHATULGA RD
COLUMBUS GA
31907-3117
US

IV. Provider business mailing address

3000 SCHATULGA RD
COLUMBUS GA
31907-3117
US

V. Phone/Fax

Practice location:
  • Phone: 706-568-5174
  • Fax:
Mailing address:
  • Phone: 706-568-5174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberNONE
License Number State

VIII. Authorized Official

Name: MS. GWENDOLYN G. MCINTOSH
Title or Position: SERVICE PROVIDER
Credential: BSN
Phone: 706-568-1678