Provider Demographics
NPI:1346510443
Name:HOSPITAL AUTHORITY OF PUTNAM COUNTY
Entity Type:Organization
Organization Name:HOSPITAL AUTHORITY OF PUTNAM COUNTY
Other - Org Name:PUTNAM GENERAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-923-2001
Mailing Address - Street 1:101 LAKE OCONEE PKWY
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-6054
Mailing Address - Country:US
Mailing Address - Phone:706-485-2711
Mailing Address - Fax:706-923-2158
Practice Address - Street 1:101 LAKE OCONEE PKWY
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-6054
Practice Address - Country:US
Practice Address - Phone:706-485-2711
Practice Address - Fax:706-923-2158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-05
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE008587333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000001537AMedicaid
GA111313Medicare Oscar/Certification