Healthcare Provider Details

I. General information

NPI: 1881315547
Provider Name (Legal Business Name): ATLANTIC GENERAL HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9714 HEALTHWAY DR
BERLIN MD
21811-1154
US

IV. Provider business mailing address

10026 OLD OCEAN CITY BLVD STE 6
BERLIN MD
21811-1288
US

V. Phone/Fax

Practice location:
  • Phone: 410-641-3340
  • Fax: 410-641-3341
Mailing address:
  • Phone: 410-641-9450
  • Fax: 410-641-9515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHERYL LEWIS NOTTINGHAM
Title or Position: CFO
Credential:
Phone: 410-641-9600