Healthcare Provider Details

I. General information

NPI: 1477697134
Provider Name (Legal Business Name): DORMINY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 09/14/2016
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: 229-424-7112
  • Fax: 229-424-7200
Mailing address:
  • Phone: 229-424-7112
  • Fax: 229-424-7200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberPHH007798
License Number StateGA

VIII. Authorized Official

Name: ARTHUR HILL
Title or Position: DIRECTOR OF PHARMACY
Credential: RPH
Phone: 229-424-7112