Healthcare Provider Details

I. General information

NPI: 1376750976
Provider Name (Legal Business Name): CRISP REGIONAL HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 03/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 HOSPITAL DR
CORDELE GA
31015-3275
US

IV. Provider business mailing address

216 HOSPITAL DR
CORDELE GA
31015-3275
US

V. Phone/Fax

Practice location:
  • Phone: 229-271-9330
  • Fax: 229-271-9245
Mailing address:
  • Phone: 229-276-2000
  • Fax: 229-276-2184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateGA

VIII. Authorized Official

Name: JAMES W. MILLER
Title or Position: DIRECTOR PHYSICIAN PRACTICES
Credential:
Phone: 229-271-4676