Basic Information
| Provider Information | |||||||||
| NPI: | 1144712738 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FLOYD CHEROKEE MEDICAL CENTER LLC | ||||||||
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| OtherOrganizationName: | FLOYD CHEROKEE PROFESSIONAL SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 E 2ND AVE STE 103 | ||||||||
| Address2: | |||||||||
| City: | ROME | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301613210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065093000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 NORTHWOOD DR | ||||||||
| Address2: | |||||||||
| City: | CENTRE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2569271300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2018 | ||||||||
| LastUpdateDate: | 06/01/2018 | ||||||||
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| AuthorizedOfficialLastName: | EARLY | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7065096177 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.