Healthcare Provider Details

I. General information

NPI: 1760632780
Provider Name (Legal Business Name): MEMORIAL HEALTH PARTNERS FOUNDATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2008
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 E VILLANOW ST
LA FAYETTE GA
30728-2618
US

IV. Provider business mailing address

PO BOX 749748
ATLANTA GA
30374-9748
US

V. Phone/Fax

Practice location:
  • Phone: 706-638-1606
  • Fax: 706-638-9987
Mailing address:
  • Phone: 423-495-8659
  • Fax: 423-495-4970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MAELOR G HUGHES
Title or Position: PRESIDENT
Credential:
Phone: 423-495-8659