Provider Demographics
NPI:1093915589
Name:EVANS MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:EVANS MEMORIAL HOSPITAL
Other - Org Name:SURGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:TATUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-739-2311
Mailing Address - Street 1:200 N RIVER ST
Mailing Address - Street 2:
Mailing Address - City:CLAXTON
Mailing Address - State:GA
Mailing Address - Zip Code:30417-1659
Mailing Address - Country:US
Mailing Address - Phone:912-739-7710
Mailing Address - Fax:912-739-7343
Practice Address - Street 1:604A EAST LONG ST
Practice Address - Street 2:
Practice Address - City:CLAXTON
Practice Address - State:GA
Practice Address - Zip Code:30417-1659
Practice Address - Country:US
Practice Address - Phone:912-739-2611
Practice Address - Fax:912-739-5041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty