Healthcare Provider Details

I. General information

NPI: 1174699466
Provider Name (Legal Business Name): MARTIN ARMY COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7950 MARTIN LOOP MCXB-N
COLUMBUS GA
31905-5647
US

IV. Provider business mailing address

7950 MARTIN LOOP MCXB-N
COLUMBUS GA
31905-5647
US

V. Phone/Fax

Practice location:
  • Phone: 706-544-2303
  • Fax: 706-544-1243
Mailing address:
  • Phone: 706-544-2303
  • Fax: 706-544-1243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number1047558
License Number StateKY

VIII. Authorized Official

Name: MRS. JUNG SAM KIM
Title or Position: FAMILY NURSE PRACTITIONER
Credential: NP
Phone: 706-544-2303