Healthcare Provider Details

I. General information

NPI: 1902013048
Provider Name (Legal Business Name): CRISP REGIONAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 SECOND AVENUE, SW
ROCHELLE GA
31079
US

IV. Provider business mailing address

636 SECOND AVENUE, SW
ROCHELLE GA
31079
US

V. Phone/Fax

Practice location:
  • Phone: 229-365-2570
  • Fax: 229-365-2571
Mailing address:
  • Phone: 229-365-2570
  • Fax: 229-365-2571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JAMES MILLER
Title or Position: DIRECTOR PHYSICIAN PRACTICES
Credential:
Phone: 229-271-4676