Healthcare Provider Details

I. General information

NPI: 1891863569
Provider Name (Legal Business Name): THE MEDICAL CENTER OF ELBERTON, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 COLLEGE AVE
ELBERTON GA
30635-1705
US

IV. Provider business mailing address

109 COLLEGE AVE
ELBERTON GA
30635-1705
US

V. Phone/Fax

Practice location:
  • Phone: 706-283-3315
  • Fax: 706-283-2159
Mailing address:
  • Phone: 706-283-3315
  • Fax: 706-283-2159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number11-3958
License Number StateGA

VIII. Authorized Official

Name: MS. BROOKE S HALL
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 706-283-3315