Provider Demographics
NPI:1093714461
Name:WACH,FORT STEWART,GA
Entity Type:Organization
Organization Name:WACH,FORT STEWART,GA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:912-435-5555
Mailing Address - Street 1:501 CREEK VIEW DR
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-3314
Mailing Address - Country:US
Mailing Address - Phone:912-876-2107
Mailing Address - Fax:
Practice Address - Street 1:1061 HARMON AVE
Practice Address - Street 2:SUITE 1 DO3 PEDIATRIC CLINIC
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-5604
Practice Address - Country:US
Practice Address - Phone:912-435-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN118721286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital