Healthcare Provider Details

I. General information

NPI: 1811020407
Provider Name (Legal Business Name): EFFINGHAM HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GOSHEN RD
RINCON GA
31326-5545
US

IV. Provider business mailing address

459 HIGHWAY 119 SOUTH ATTN: ALIA ALLEN/MEDICAL STAFF OFFICE
SPRINGFIELD GA
31329
US

V. Phone/Fax

Practice location:
  • Phone: 912-826-6000
  • Fax: 912-826-6016
Mailing address:
  • Phone: 912-754-0175
  • Fax: 912-754-6395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberRN057176NP
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateGA

VIII. Authorized Official

Name: MRS. FRANCINE BAKER-WITT
Title or Position: INTERIM CEO
Credential: RN, MBA, CNHA
Phone: 912-754-0142