Basic Information
| Provider Information | |||||||||
| NPI: | 1477893857 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EFFINGHAM HOSPITAL, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | EFFINGHAM HEALTH SYSTEM | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 459 HWY 119 S | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313293021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9127546451 | ||||||||
| FaxNumber: | 9127542570 | ||||||||
| Practice Location | |||||||||
| Address1: | 459 GA HIGHWAY 119 S | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313293021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9127540422 | ||||||||
| FaxNumber: | 9127540305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2013 | ||||||||
| LastUpdateDate: | 08/10/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WITT | ||||||||
| AuthorizedOfficialFirstName: | FRANCINE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9127540160 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | PHD | ||||||||
| NPICertificationDate: | 08/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | PHRE010321 | GA | N | Suppliers | Pharmacy | Community/Retail Pharmacy | 3336I0012X | PHH007975 | GA | Y | Suppliers | Pharmacy | Institutional Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 1163219 | 01 | NCPDP PROVIDER IDENTIFICATION NUMBER | OTHER |