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General NPI Number Information
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NPI Number | 1578660742
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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 | 09/20/2006
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 300 W HOSPITAL RD BLDG W
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City | FORT 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 | 706-787-5811
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Fax |
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Provider Business Mailing Address
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Address Line | 300 W HOSPITAL RD BLDG W ATTN MCHF-PAD
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City | FORT 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 | 706-787-1125
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Fax |
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Authorized Official
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Title or Position | UBO MANAGER
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Name | KIMBERLY BROWN
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Credential |
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Telephone | 706-787-7172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1100X
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Taxonomy Name | Military/U.S. Coast Guard Outpatient Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1101X
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Taxonomy Name | Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2865M2000X
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Taxonomy Name | Military General Acute Care Hospital
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License Number |
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License Number State |
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