Healthcare Provider Details

I. General information

NPI: 1194378083
Provider Name (Legal Business Name): MAURY REGIONAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2019
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 TROTWOOD AVE STE 603
COLUMBIA TN
38401-6410
US

IV. Provider business mailing address

PO BOX 100054
ATLANTA GA
30348-0054
US

V. Phone/Fax

Practice location:
  • Phone: 931-490-1295
  • Fax: 931-490-1298
Mailing address:
  • Phone: 931-796-4901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GREGORY A WHITLOCK
Title or Position: VP FINANCE/IT
Credential:
Phone: 931-540-4212