Basic Information
| Provider Information | |||||||||
| NPI: | 1811020407 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EFFINGHAM HOSPITAL, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | EFFINGHAM FAMILY MEDICINE AT GOSHEN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 459 HIGHWAY 119 SOUTH | ||||||||
| Address2: | ATTN: ALIA ALLEN/MEDICAL STAFF OFFICE | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9127540175 | ||||||||
| FaxNumber: | 9127546395 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 GOSHEN RD | ||||||||
| Address2: | |||||||||
| City: | RINCON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313265545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9128266000 | ||||||||
| FaxNumber: | 9128266016 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2007 | ||||||||
| LastUpdateDate: | 11/29/2016 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BAKER-WITT | ||||||||
| AuthorizedOfficialFirstName: | FRANCINE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | INTERIM CEO | ||||||||
| AuthorizedOfficialTelephone: | 9127540142 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | RN, MBA, CNHA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | RN057176NP | GA | N | Ambulatory Health Care Facilities | Clinic/Center | 261Q00000X | N | Ambulatory Health Care Facilities | Clinic/Center | 261QR1300X | GA | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.