Provider Demographics
NPI:1558436634
Name:MEDICAL COLLEGE OF GEORGIA HOSPITAL
Entity Type:Organization
Organization Name:MEDICAL COLLEGE OF GEORGIA HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCAITE PROFESSOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DORTH
Authorized Official - Middle Name:GREER
Authorized Official - Last Name:FALLS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:706-721-7453
Mailing Address - Street 1:747 MAGRUDER LNDG
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-4063
Mailing Address - Country:US
Mailing Address - Phone:706-868-0644
Mailing Address - Fax:706-721-7781
Practice Address - Street 1:1120 15TH ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0004
Practice Address - Country:US
Practice Address - Phone:706-721-7453
Practice Address - Fax:706-721-7781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA026773282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital