MEDICARE: EFFINGHAM HOSPITAL, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083X0100X	Occupational Medicine Physician

General Provider Information

NPI Number	:	1245668417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EFFINGHAM HOSPITAL, INC.

Provider Business Mailing Address
First Line	:	459 HIGHWAY 119 SOUTH
Second Line	:	ATTN.: ALIA ALLEN/MEDICAL STAFF OFFICE
City	:	SPRINGFIELD
State	:	GA
Zip	:	31329
Country	:	US
Telephone Number	:	912-754-0175
Fax Number	:	912-754-6395

Provider Business Practice Location Address
First Line	:	7306 GA HIGHWAY 21 STE 105
Second Line	:
City	:	PORT WENTWORTH
State	:	GA
Zip	:	31407-9275
Country	:	US
Telephone Number	:	912-966-2575
Fax Number	:	912-966-0906

Authorized Official
Title or Position	:	CEO
Name	:	DR. FRAN BAKER-WITT
Credential	:	DNP, MBA, LNHA, RN
Telephone Number	:	912-754-0175

Provider Enumeration Date	:	10/24/2013
Last Update Date	:	06/07/2021

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