MEDICARE: MARTIN ARMY COMMUNITY HOSPITAL

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	286500000X	Military Hospital	LD002620	GA

General Provider Information

NPI Number	:	1275670200
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARTIN ARMY COMMUNITY HOSPITAL

Provider Business Mailing Address
First Line	:	7950 MARTIN LOOP
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31905
Country	:	US
Telephone Number	:	334-298-9578
Fax Number	:

Provider Business Practice Location Address
First Line	:	7950 MARTIN LOOP
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31905
Country	:	US
Telephone Number	:	334-298-9578
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED OUTPATIENT DIETITIAN
Name	:	MRS. JENNIFER CHRISTIN WICKER
Credential	:	RD, LD
Telephone Number	:	706-544-3856

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	08/22/2020

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