Basic Information
| Provider Information | |||||||||
| NPI: | 1174272892 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CRISP REGIONAL HOSPITAL, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 531739 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303531739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2292712180 | ||||||||
| FaxNumber: | 2292763638 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 E 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | CORDELE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310153620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2292762180 | ||||||||
| FaxNumber: | 2292763638 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2022 | ||||||||
| LastUpdateDate: | 03/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | CARTER | ||||||||
| AuthorizedOfficialFirstName: | JESSICA | ||||||||
| AuthorizedOfficialMiddleName: | YATES | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2292763100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.