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General NPI Number Information
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NPI Number | 1174927875
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Entity Type | Organization
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Legal Business Name | MORGAN COUNTY GEORGIA HOSPITAL AUTHORITY
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Dates
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Enumeration Date | 10/09/2014
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Last Update Date | 10/09/2014
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Provider Practice Location Address
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Address Line | 1077 S MAIN ST
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City | MADISON
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State | GA
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Zip | 30650-2073
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Country | US
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Telephone | 706-342-1667
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Fax | 706-342-2046
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Provider Business Mailing Address
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Address Line | 1077 S MAIN ST
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City | MADISON
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State | GA
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Zip | 30650-2073
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Country | US
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Telephone | 706-342-1667
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Fax | 706-342-2046
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Authorized Official
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Title or Position | CEO
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Name | RALPH CASTILLO
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Credential |
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Telephone | 706-342-1667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PHH003657
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License Number State | GA
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