Healthcare Provider Details

I. General information

NPI: 1730433152
Provider Name (Legal Business Name): UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 02/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 WASHINGTON RD
THOMSON GA
30824-6600
US

IV. Provider business mailing address

2460 WASHINGTON RD
THOMSON GA
30824-6600
US

V. Phone/Fax

Practice location:
  • Phone: 706-595-1411
  • Fax: 706-597-5139
Mailing address:
  • Phone: 706-595-1411
  • Fax: 706-597-5141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MR. BOB KEPSHIRE
Title or Position: ADMINISTRATOR / CNO
Credential: MS, MA, RN, CENP
Phone: 706-595-1411