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General NPI Number Information
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NPI Number | 1215036983
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Entity Type | Organization
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Legal Business Name | AMC EISENHOWER
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | AVENUE B BLDG 29709 MARK CONNELLY HEALTH CLINIC
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City | FT GORDON
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State | GA
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Zip | 30905
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Country | US
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Telephone | 706-787-5167
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Fax | 706-787-6175
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Provider Business Mailing Address
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Address Line | EISENHOWER ARMY MEDICAL CENTER ATTN MCHF-PAD
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City | FT GORDON
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State | GA
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Zip | 30905-5741
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Country | US
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Telephone | 706-787-5167
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Fax | 706-787-6175
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Authorized Official
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Title or Position | DHA POD SR PROGRAM ANALYST
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Name | HECTOR MORALES
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Credential |
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Telephone | 210-536-6650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332000000X
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Taxonomy Name | Military/U.S. Coast Guard Pharmacy
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License Number |
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License Number State |
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