Provider Demographics
NPI:1417209081
Name:DECATUR GENERAL HOSPITAL
Entity Type:Organization
Organization Name:DECATUR GENERAL HOSPITAL
Other - Org Name:WOMEN'S HEALTHCARE OF DECATUR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-341-2000
Mailing Address - Street 1:1304 13TH AVE SE
Mailing Address - Street 2:SUITE C
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-4359
Mailing Address - Country:US
Mailing Address - Phone:256-355-9216
Mailing Address - Fax:
Practice Address - Street 1:1304 13TH AVE SE
Practice Address - Street 2:SUITE C
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4359
Practice Address - Country:US
Practice Address - Phone:256-355-9216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.14320207VG0400X
ALMD.8779207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALK549Medicare PIN