Provider Demographics
NPI:1174272892
Name:CRISP REGIONAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:CRISP REGIONAL HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:YATES
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-276-3100
Mailing Address - Street 1:PO BOX 531739
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-1739
Mailing Address - Country:US
Mailing Address - Phone:229-271-2180
Mailing Address - Fax:229-276-3638
Practice Address - Street 1:401 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-3620
Practice Address - Country:US
Practice Address - Phone:229-276-2180
Practice Address - Fax:229-276-3638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty