Provider Demographics
NPI:1710099098
Name:CHARLTON MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:CHARLTON MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-496-2531
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:2449 THIRD ST
Mailing Address - City:FOLKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:31537-0188
Mailing Address - Country:US
Mailing Address - Phone:912-496-2531
Mailing Address - Fax:912-496-7766
Practice Address - Street 1:2449 THIRD ST
Practice Address - Street 2:
Practice Address - City:FOLKSTON
Practice Address - State:GA
Practice Address - Zip Code:31537-8919
Practice Address - Country:US
Practice Address - Phone:912-496-2531
Practice Address - Fax:912-496-7766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024-106275N00000X
GA024106282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000000338A0Medicaid
FL010341100Medicaid
GA000000338A0Medicaid
11Z315Medicare Oscar/Certification