Healthcare Provider Details

I. General information

NPI: 1316997760
Provider Name (Legal Business Name): ARCHBOLD HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 MIMOSA DR
THOMASVILLE GA
31792-6605
US

IV. Provider business mailing address

PO BOX 620
THOMASVILLE GA
31799-0620
US

V. Phone/Fax

Practice location:
  • Phone: 229-228-2783
  • Fax: 229-551-8732
Mailing address:
  • Phone: 229-228-2783
  • Fax: 229-551-8732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License NumberESRD001121
License Number StateGA

VIII. Authorized Official

Name: MR. WILLIAM CLAY CAMPBELL
Title or Position: EXEC. VICE PRESIDENT
Credential:
Phone: 229-228-2200