Basic Information
| Provider Information | |||||||||
| NPI: | 1003406463 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TMC/HIGGINS GENERAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 PROFESSIONAL PL STE 305 | ||||||||
| Address2: | |||||||||
| City: | CARROLLTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301173872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708128614 | ||||||||
| FaxNumber: | 7708128372 | ||||||||
| Practice Location | |||||||||
| Address1: | 706 DIXIE ST STE 140 | ||||||||
| Address2: | |||||||||
| City: | CARROLLTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301173859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708128614 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2021 | ||||||||
| LastUpdateDate: | 01/20/2021 | ||||||||
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| AuthorizedOfficialLastName: | CREWS | ||||||||
| AuthorizedOfficialFirstName: | CAROL | ||||||||
| AuthorizedOfficialMiddleName: | S. | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7708129745 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TMC HIGGINS GENERAL HOSPITAL, INC | ||||||||
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| NPICertificationDate: | 01/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
No ID Information.