Healthcare Provider Details

I. General information

NPI: 1184810509
Provider Name (Legal Business Name): PUTNAM GENERAL HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 LAKE OCONEE PKWY
EATONTON GA
31024-6054
US

IV. Provider business mailing address

101 LAKE OCONEE PKWY
EATONTON GA
31024-6054
US

V. Phone/Fax

Practice location:
  • Phone: 706-923-2002
  • Fax: 706-485-2072
Mailing address:
  • Phone: 706-923-2002
  • Fax: 706-485-2072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number117216
License Number StateGA

VIII. Authorized Official

Name: MS. ANITA W CULBERSON
Title or Position: REVENUE CYCLE DIRECTOR
Credential:
Phone: 706-923-2006