Healthcare Provider Details

I. General information

NPI: 1891999090
Provider Name (Legal Business Name): MARTIN ARMY COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3255 SAND HILL, 11TH ABN DIV RD
FORT BENNING GA
31905
US

IV. Provider business mailing address

6600 VAN AALST BLVD BLDG 9250 ATTN MCXB-PP
FORT BENNING GA
31905-2102
US

V. Phone/Fax

Practice location:
  • Phone: 706-544-9071
  • Fax:
Mailing address:
  • Phone: 762-408-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1100X
TaxonomyMilitary/U.S. Coast Guard Outpatient Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KERTREDIA DAVIS
Title or Position: UBO MANAGER
Credential: MS, CRCR, CHLIS
Phone: 762-408-0007