Healthcare Provider Details

I. General information

NPI: 1891770764
Provider Name (Legal Business Name): PHOEBE WORTH MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 W FRANKLIN ST
SYLVESTER GA
31791-1978
US

IV. Provider business mailing address

PO BOX 545 807 S ISABELLA STREET
SYLVESTER GA
31791-0545
US

V. Phone/Fax

Practice location:
  • Phone: 229-776-2965
  • Fax: 229-776-4452
Mailing address:
  • Phone: 229-776-2965
  • Fax: 229-776-4452

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: STACEY L FLYNT
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 229-777-4514