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General NPI Number Information
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NPI Number | 1790076966
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Entity Type | Organization
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Legal Business Name | CRISP REGIONAL HOSPITAL
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Dates
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Enumeration Date | 04/22/2011
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Last Update Date | 04/22/2011
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Provider Practice Location Address
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Address Line | 910 N 5TH ST
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City | CORDELE
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State | GA
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Zip | 31015-3254
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Country | US
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Telephone | 229-271-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 910 N 5TH ST
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City | CORDELE
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State | GA
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Zip | 31015-3254
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Country | US
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Telephone | 229-271-4600
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Fax |
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Authorized Official
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Title or Position | OBSTETRICIAN/GYNECOLOGIST
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Name | DR. SAMANTHA DAHLIA BORELAND
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Credential | MD,MHSA
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Telephone | 229-276-3101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NW0100X
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Taxonomy Name | Women's Hospital
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License Number | 65938
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License Number State | GA
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