Provider Demographics
NPI:1033595327
Name:IRWIN COUNTY HOSPITAL
Entity Type:Organization
Organization Name:IRWIN COUNTY HOSPITAL
Other - Org Name:IRWIN PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-468-3862
Mailing Address - Street 1:710 N IRWIN AVE
Mailing Address - Street 2:
Mailing Address - City:OCILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31774-5011
Mailing Address - Country:US
Mailing Address - Phone:229-468-3800
Mailing Address - Fax:229-468-9991
Practice Address - Street 1:200 S CHERRY ST
Practice Address - Street 2:
Practice Address - City:OCILLA
Practice Address - State:GA
Practice Address - Zip Code:31774-1804
Practice Address - Country:US
Practice Address - Phone:229-468-5020
Practice Address - Fax:229-468-5024
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IRWIN COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-10
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty