Healthcare Provider Details

I. General information

NPI: 1902073844
Provider Name (Legal Business Name): THE MEDICAL CENTER HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 09/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FRIST CT
COLUMBUS GA
31909-3578
US

IV. Provider business mailing address

707 CENTER ST SUITE 400
COLUMBUS GA
31901-1575
US

V. Phone/Fax

Practice location:
  • Phone: 706-494-2100
  • Fax: 706-494-2446
Mailing address:
  • Phone: 706-660-6103
  • Fax: 706-660-6520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number106-645
License Number StateGA

VIII. Authorized Official

Name: DAVID B MCMICKEN
Title or Position: CHAIRMAN OF BOARD OF DIRECTORS
Credential: M.D.
Phone: 706-660-6103