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General NPI Number Information
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NPI Number | 1902128077
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Entity Type | Organization
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Legal Business Name | MARTIN ARMY COMMUNITY HOSPITAL
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Dates
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Enumeration Date | 02/17/2010
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Last Update Date | 02/17/2010
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Provider Practice Location Address
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Address Line | 7191 KANOPSKY AVE BLDG. #2625
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City | FORT BENNING
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State | GA
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Zip | 31905-4540
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Country | US
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Telephone | 706-545-1661
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Fax | 706-545-1695
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Provider Business Mailing Address
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Address Line | 7950 MARTIN LOOP
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City | FORT BENNING
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State | GA
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Zip | 31905-5647
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALS MANAGER
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Name | MS. ELAINE MORGAN
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Credential |
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Telephone | 706-544-5195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1102X
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Taxonomy Name | Military Outpatient Operational (Transportable) Component Clinic/Center
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License Number |
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License Number State |
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