Healthcare Provider Details

I. General information

NPI: 1043875594
Provider Name (Legal Business Name): LIBERTY REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 ELMA G. MILES PARKWAY
HINESVILLE GA
31313
US

IV. Provider business mailing address

462 ELMA G. MILES PARKWAY
HINESVILLE GA
31313
US

V. Phone/Fax

Practice location:
  • Phone: 912-369-9478
  • Fax: 800-611-2089
Mailing address:
  • Phone: 912-369-9478
  • Fax: 800-611-2089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROBERT DEREK ROZIER
Title or Position: CFO
Credential:
Phone: 912-369-9427