Provider Demographics
NPI:1639296395
Name:THE MEDICAL CENTER OF CENTRAL GEORGIA, INC.
Entity Type:Organization
Organization Name:THE MEDICAL CENTER OF CENTRAL GEORGIA, INC.
Other - Org Name:AHC PHARMACY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHREWSBURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-633-1452
Mailing Address - Street 1:764 PINE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2107
Mailing Address - Country:US
Mailing Address - Phone:478-633-1145
Mailing Address - Fax:478-633-2849
Practice Address - Street 1:764 PINE ST STE 100
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2107
Practice Address - Country:US
Practice Address - Phone:478-633-1145
Practice Address - Fax:478-633-2849
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MEDICAL CENTER OF CENTRAL GEORGIA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-26
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0022823336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy