Provider Demographics
NPI:1417246968
Name:DOCTORS HOSPITAL CENTER FOR OCCUPATIONAL MEDICINE
Entity Type:Organization
Organization Name:DOCTORS HOSPITAL CENTER FOR OCCUPATIONAL MEDICINE
Other - Org Name:CENTER FOR OCCUPATIONAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-651-6008
Mailing Address - Street 1:2215 TOBACCO RD STE F
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-8112
Mailing Address - Country:US
Mailing Address - Phone:706-396-1140
Mailing Address - Fax:706-396-1155
Practice Address - Street 1:2215 TOBACCO RD STE F
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-8112
Practice Address - Country:US
Practice Address - Phone:706-396-1140
Practice Address - Fax:706-396-1155
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOCTORS HOSPITAL OF AUGUSTA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine