Provider Demographics
NPI:1225282148
Name:DOCTORS HOSPITAL, INC.
Entity Type:Organization
Organization Name:DOCTORS HOSPITAL, INC.
Other - Org Name:DOCTORS HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT AND COO
Authorized Official - Prefix:MR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:B
Authorized Official - Last Name:DUKE
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE
Authorized Official - Phone:706-571-1200
Mailing Address - Street 1:707 CENTER ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-1575
Mailing Address - Country:US
Mailing Address - Phone:706-660-6103
Mailing Address - Fax:706-660-6520
Practice Address - Street 1:616 19TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1528
Practice Address - Country:US
Practice Address - Phone:706-494-4381
Practice Address - Fax:706-494-4156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA106-652282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000148233AMedicaid
110186Medicare Oscar/Certification