Healthcare Provider Details

I. General information

NPI: 1104550342
Provider Name (Legal Business Name): BURKE HOSPITAL COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 HWY 119 S
SPRINGFIELD GA
31329-3021
US

IV. Provider business mailing address

459 HWY 119 S
SPRINGFIELD GA
31329-3021
US

V. Phone/Fax

Practice location:
  • Phone: 912-542-0444
  • Fax: 833-639-1102
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL S HESTER
Title or Position: CEO
Credential:
Phone: 912-369-9400