Basic Information
| Provider Information | |||||||||
| NPI: | 1669488250 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ELBERT MEMORIAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 MEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | ELBERTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306351830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062833151 | ||||||||
| FaxNumber: | 7062838609 | ||||||||
| Practice Location | |||||||||
| Address1: | 4 MEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | ELBERTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306351830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062833151 | ||||||||
| FaxNumber: | 7062838609 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 03/18/2020 | ||||||||
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| AuthorizedOfficialLastName: | SCOGGINS | ||||||||
| AuthorizedOfficialFirstName: | BRANDY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SR. GOVERNMENTAL ACCOUNTANT | ||||||||
| AuthorizedOfficialTelephone: | 7062132516 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 52-46 | GA | N | Hospitals | General Acute Care Hospital | 282NC0060X | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 000000668S | 05 | GA | MEDICAID | 00000668A | 05 | GA | MEDICAID |