Provider Demographics
NPI:1407137250
Name:GEORGIA REGIONAL HOSPITAL
Entity Type:Organization
Organization Name:GEORGIA REGIONAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILE
Authorized Official - Middle Name:
Authorized Official - Last Name:RISBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-243-2100
Mailing Address - Street 1:3073 PANTHERVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-3828
Mailing Address - Country:US
Mailing Address - Phone:404-243-2100
Mailing Address - Fax:404-212-4702
Practice Address - Street 1:3073 PANTHERSVILLE RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-3828
Practice Address - Country:US
Practice Address - Phone:404-243-2100
Practice Address - Fax:404-212-4702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN119661 CNS/PMH282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital