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General NPI Number Information
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NPI Number | 1174699466
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Entity Type | Organization
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Legal Business Name | MARTIN ARMY COMMUNITY HOSPITAL
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7950 MARTIN LOOP MCXB-N
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City | COLUMBUS
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State | GA
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Zip | 31905-5647
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Country | US
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Telephone | 706-544-2303
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Fax | 706-544-1243
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Provider Business Mailing Address
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Address Line | 7950 MARTIN LOOP MCXB-N
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City | COLUMBUS
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State | GA
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Zip | 31905-5647
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Country | US
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Telephone | 706-544-2303
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Fax | 706-544-1243
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | MRS. JUNG SAM KIM
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Credential | NP
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Telephone | 706-544-2303
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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 | 1047558
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License Number State | KY
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