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General NPI Number Information
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NPI Number | 1740446905
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Entity Type | Organization
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Legal Business Name | DDEAMC
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Dates
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Enumeration Date | 08/06/2008
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Last Update Date | 08/06/2008
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Provider Practice Location Address
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Address Line | 300 W HOSPITAL RD
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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 | 706-787-9253
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Fax | 706-787-9356
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Provider Business Mailing Address
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Address Line | 300 W HOSPITAL RD
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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 | 706-787-9253
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Fax | 706-787-9356
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Authorized Official
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Title or Position | LPN
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Name | MRS. CAROLYN L. JONES
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Credential |
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Telephone | 706-787-9253
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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 | LPN024837
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License Number State | GA
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