Healthcare Provider Details

I. General information

NPI: 1891083085
Provider Name (Legal Business Name): PHOEBE DORMINY MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PERRY HOUSE RD
FITZGERALD GA
31750-8857
US

IV. Provider business mailing address

200 PERRY HOUSE RD
FITZGERALD GA
31750-8857
US

V. Phone/Fax

Practice location:
  • Phone: 229-424-7100
  • Fax: 229-424-7281
Mailing address:
  • Phone: 229-424-7100
  • Fax: 229-424-7281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. PAIGE P WYNN
Title or Position: CFO
Credential:
Phone: 229-424-7100