Healthcare Provider Details

I. General information

NPI: 1306055454
Provider Name (Legal Business Name): SOUTHWEST GA REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 RANDOLPH ST
CUTHBERT GA
39840-1338
US

IV. Provider business mailing address

109 RANDOLPH ST
CUTHBERT GA
39840-1338
US

V. Phone/Fax

Practice location:
  • Phone: 229-732-2181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHRISTY LUMPKIN
Title or Position: BUSINESS OFFICE
Credential:
Phone: 229-732-2181