Healthcare Provider Details

I. General information

NPI: 1669861530
Provider Name (Legal Business Name): MEMORIAL HEALTH PARTNERS FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2015
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 E VILLANOW ST
LA FAYETTE GA
30728-2618
US

IV. Provider business mailing address

611 E VILLANOW ST
LA FAYETTE GA
30728-2618
US

V. Phone/Fax

Practice location:
  • Phone: 706-638-1606
  • Fax: 706-638-9987
Mailing address:
  • Phone: 706-638-1606
  • Fax: 706-638-9987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: RAMON FIGUEROA
Title or Position: DIRECTOR PHYSICIAN OPERATIONS
Credential:
Phone: 423-424-1551