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General NPI Number Information
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NPI Number | 1093714461
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Entity Type | Organization
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Legal Business Name | WACH,FORT STEWART,GA
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1061 HARMON AVE SUITE 1 DO3 PEDIATRIC CLINIC
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City | FORT STEWART
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State | GA
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Zip | 31314-5604
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Country | US
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Telephone | 912-435-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 501 CREEK VIEW DR
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City | HINESVILLE
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State | GA
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Zip | 31313-3314
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Country | US
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Telephone | 912-876-2107
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Fax |
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Authorized Official
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Title or Position | CLINICAL NURSE
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Name | MRS. MARIA S. RODRIGUEZ
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Credential | R.N.
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Telephone | 912-435-5555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 286500000X
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Taxonomy Name | Military Hospital
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License Number | RN118721
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License Number State | GA
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