Healthcare Provider Details

I. General information

NPI: 1184673030
Provider Name (Legal Business Name): JOHN D. ARCHBOLD MEMORIAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 E. PINETREE BLVD
THOMASVILLE GA
31792-4875
US

IV. Provider business mailing address

2705 E. PINETREE BLVD
THOMASVILLE GA
31792-4875
US

V. Phone/Fax

Practice location:
  • Phone: 229-551-2365
  • Fax: 229-225-9382
Mailing address:
  • Phone: 229-551-2365
  • Fax: 229-225-9382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: TARA KING
Title or Position: AVP
Credential:
Phone: 229-228-2229