Healthcare Provider Details

I. General information

NPI: 1700851649
Provider Name (Legal Business Name): CRISP REGIONAL HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 7TH ST NORTH
CORDELE GA
31010
US

IV. Provider business mailing address

PO BOX 5007
CORDELE GA
31015-5007
US

V. Phone/Fax

Practice location:
  • Phone: 229-271-9686
  • Fax: 229-271-9689
Mailing address:
  • Phone: 229-271-9686
  • Fax: 229-271-9689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number040495
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number040495
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LYNN RENEE BEARDEN
Title or Position: DIR REV INT
Credential:
Phone: 229-276-3146