Provider Demographics
NPI:1003937723
Name:PHOEBE PUTNEY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:PHOEBE PUTNEY MEMORIAL HOSPITAL
Other - Org Name:PHOEBE FAMILY MEDICINE- LEESBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHYSICIAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:F
Authorized Official - Last Name:MIDDLETON
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:229-312-4055
Mailing Address - Street 1:PO BOX 2548
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31702-2548
Mailing Address - Country:US
Mailing Address - Phone:229-312-5870
Mailing Address - Fax:229-312-5853
Practice Address - Street 1:1390 US HIGHWAY 19 S
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:GA
Practice Address - Zip Code:31763-4831
Practice Address - Country:US
Practice Address - Phone:229-889-7490
Practice Address - Fax:229-889-7495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty