Provider Demographics
NPI:1669488250
Name:ELBERT MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:ELBERT MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. GOVERNMENTAL ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-213-2516
Mailing Address - Street 1:4 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:ELBERTON
Mailing Address - State:GA
Mailing Address - Zip Code:30635-1830
Mailing Address - Country:US
Mailing Address - Phone:706-283-3151
Mailing Address - Fax:706-283-8609
Practice Address - Street 1:4 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:ELBERTON
Practice Address - State:GA
Practice Address - Zip Code:30635-1830
Practice Address - Country:US
Practice Address - Phone:706-283-3151
Practice Address - Fax:706-283-8609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA52-46282N00000X
282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000000668SMedicaid
GA00000668AMedicaid
GA00000668AMedicaid
GA000000668SMedicaid