Provider Demographics
NPI:1578854832
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:30809
Mailing Address - Country:US
Mailing Address - Phone:706-396-1140
Mailing Address - Fax:706-396-1155
Practice Address - Street 1:635 RONALD REAGAN DR STE 1
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809
Practice Address - Country:US
Practice Address - Phone:706-922-5056
Practice Address - Fax:706-922-5094
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOCTORS HOSPITAL OF AUGUSTA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-21
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine