MEDICARE: JOHN D. ARCHBOLD MEMORIAL 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	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	ESRD004044	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356372304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN D. ARCHBOLD MEMORIAL HOSPITAL, INC.

Provider Business Mailing Address
First Line	:	920 CAIRO RD
Second Line	:
City	:	THOMASVILLE
State	:	GA
Zip	:	31792-4255
Country	:	US
Telephone Number	:	229-228-8800
Fax Number	:	229-228-8892

Provider Business Practice Location Address
First Line	:	101 E DAVIS ST
Second Line	:
City	:	QUITMAN
State	:	GA
Zip	:	31643-1407
Country	:	US
Telephone Number	:	229-263-6340
Fax Number	:	229-263-6330

Authorized Official
Title or Position	:	CFO
Name	:	MR. GREGORY S. HEMBREE
Credential	:
Telephone Number	:	229-228-2880

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	03/08/2017

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