Healthcare Provider Details

I. General information

NPI: 1710099098
Provider Name (Legal Business Name): CHARLTON MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2449 THIRD ST
FOLKSTON GA
31537-8919
US

IV. Provider business mailing address

PO BOX 188 2449 THIRD ST
FOLKSTON GA
31537-0188
US

V. Phone/Fax

Practice location:
  • Phone: 912-496-2531
  • Fax: 912-496-7766
Mailing address:
  • Phone: 912-496-2531
  • Fax: 912-496-7766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number024-106
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number024106
License Number StateGA

VIII. Authorized Official

Name: KIMBERLY SAVAGE
Title or Position: CFO
Credential:
Phone: 912-496-2531