Provider Demographics
NPI:1508002825
Name:WEST CENTRAL GEORGIA REGIONAL HOSPITAL
Entity Type:Organization
Organization Name:WEST CENTRAL GEORGIA REGIONAL HOSPITAL
Other - Org Name:WEST CENTRAL ADULT MOBILE CRISIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TEAM LEADER / SSP II
Authorized Official - Prefix:MS
Authorized Official - First Name:MERIBETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PILLOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-568-5146
Mailing Address - Street 1:1225 3RD AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-2596
Mailing Address - Country:US
Mailing Address - Phone:706-568-5146
Mailing Address - Fax:
Practice Address - Street 1:1225 3RD AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-2596
Practice Address - Country:US
Practice Address - Phone:706-568-5146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherFEI #