Provider Demographics
NPI:1225072846
Name:PHOEBE PUTNEY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:PHOEBE PUTNEY MEMORIAL HOSPITAL
Other - Org Name:SICKLE CELL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP PHYSICIAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:F
Authorized Official - Last Name:MIDDLETON
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:229-312-4055
Mailing Address - Street 1:PO BOX 2548
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31702-2548
Mailing Address - Country:US
Mailing Address - Phone:229-312-5800
Mailing Address - Fax:229-312-5853
Practice Address - Street 1:507 W 3RD AVE
Practice Address - Street 2:STE 100
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1958
Practice Address - Country:US
Practice Address - Phone:229-312-9050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040445207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAHOSP7Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER