Healthcare Provider Details

I. General information

NPI: 1316273360
Provider Name (Legal Business Name): DWIGHT D. EISENHOWER ARMY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2009
Last Update Date: 10/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W HOSPITAL RD
FORT GORDON GA
30905-5741
US

IV. Provider business mailing address

300 HOSPITAL ROAD
APO AA
30905
US

V. Phone/Fax

Practice location:
  • Phone: 706-787-9358
  • Fax:
Mailing address:
  • Phone: 706-787-9358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL FRIEDMAN
Title or Position: PROGRAM DIRECTOR
Credential: M.D.
Phone: 706-787-9358