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General NPI Number Information
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NPI Number | 1821293788
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Entity Type | Organization
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Legal Business Name | PHOEBE PUTNEY MEMORIAL HOSPITAL, INC.
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 05/30/2014
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Provider Practice Location Address
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Address Line | 48 US HIGHWAY 19 S
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City | CAMILLA
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State | GA
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Zip | 31730-1960
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Country | US
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Telephone | 229-336-5208
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Fax | 229-336-8260
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Provider Business Mailing Address
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Address Line | PO BOX 3109
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City | ALBANY
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State | GA
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Zip | 31706-3109
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Country | US
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Telephone | 229-312-5800
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Fax | 229-312-5853
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Authorized Official
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Title or Position | SR VP PHYSICIAN SERVICES
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Name | ROBERT LAGESSE
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Credential |
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Telephone | 229-312-4055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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