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General NPI Number Information
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NPI Number | 1699773077
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Entity Type | Organization
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Legal Business Name | PHOEBE PUTNEY MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 07/11/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 417 W 3RD AVE LABORATORY
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City | ALBANY
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State | GA
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Zip | 31701-1943
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Country | US
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Telephone | 229-312-6198
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Fax | 229-312-6105
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Provider Business Mailing Address
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Address Line | 417 W 3RD AVE
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City | ALBANY
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State | GA
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Zip | 31701-1943
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Country | US
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Telephone | 229-312-6198
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Fax | 229-312-6105
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Authorized Official
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Title or Position | CFO
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Name | MR. KERRY LOUDERMILK
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Credential |
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Telephone | 229-312-4068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 047-003
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License Number State | GA
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