Provider Demographics
NPI:1144224767
Name:GEORGIA DEPARTMENT OF HUMAN RESOURCES
Entity Type:Organization
Organization Name:GEORGIA DEPARTMENT OF HUMAN RESOURCES
Other - Org Name:WEST CENTRAL GEORGIA REGIONAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:YEKEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADERIBIGBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-568-5209
Mailing Address - Street 1:3000 SCHATULGA RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-3117
Mailing Address - Country:US
Mailing Address - Phone:706-568-5000
Mailing Address - Fax:706-568-5339
Practice Address - Street 1:3000 SCHATULGA RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-3117
Practice Address - Country:US
Practice Address - Phone:706-568-5000
Practice Address - Fax:706-568-5339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAA-106-291283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11 4013Medicare ID - Type Unspecified
GA114013Medicare ID - Type Unspecified
GA11-4013 GAMedicare ID - Type Unspecified
GA11 4013 GAMedicare ID - Type Unspecified
GA11 4013GAMedicare ID - Type Unspecified
GA11-4013Medicare ID - Type Unspecified
GA11-4013GAMedicare ID - Type Unspecified
GAW22391Medicare UPIN
GA114013 GAMedicare ID - Type Unspecified
GA114013GAMedicare ID - Type Unspecified