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General NPI Number Information
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NPI Number | 1861769846
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Entity Type | Organization
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Legal Business Name | US ARMY, 3ID, 3BCT, SLEDGEHAMMER TMC
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Dates
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Enumeration Date | 11/19/2011
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Last Update Date | 11/19/2011
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Provider Practice Location Address
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Address Line | BLDG 9052, WATKINS AVE SLEDGEHAMMER TMC,
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City | FT BENNING
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State | GA
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Zip | 31905
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Country | US
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Telephone | 706-544-3290
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Fax | 706-544-1113
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Provider Business Mailing Address
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Address Line | 1028 CROSSWINDS DR
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City | MIDLAND
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State | GA
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Zip | 31820-4859
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Country | US
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Telephone | 931-538-2222
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Fax |
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Authorized Official
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Title or Position | BN PA
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Name | MR. KEVIN M HUGHES
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Credential | PA-C
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Telephone | 706-544-3290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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