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General NPI Number Information
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NPI Number | 1114184777
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Entity Type | Organization
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Legal Business Name | FEDERAL GOVERNMENT
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Dates
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Enumeration Date | 05/21/2008
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 1061 HARMON AVE
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City | FORT STEWART
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State | GA
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Zip | 31314-5641
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Country | US
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Telephone | 912-435-5454
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Fax |
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Provider Business Mailing Address
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Address Line | 1061 HARMON AVE
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City | FORT STEWART
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State | GA
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Zip | 31314-5641
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF ADMINISTRATOR
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Name | BONITA PORTER
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Credential |
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Telephone | 912-435-6633
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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 | GA4170
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License Number State | GA
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