Provider Demographics
NPI:1790076966
Name:CRISP REGIONAL HOSPITAL
Entity Type:Organization
Organization Name:CRISP REGIONAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OBSTETRICIAN/GYNECOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:DAHLIA
Authorized Official - Last Name:BORELAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD,MHSA
Authorized Official - Phone:229-276-3101
Mailing Address - Street 1:910 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31015-3254
Mailing Address - Country:US
Mailing Address - Phone:229-271-4600
Mailing Address - Fax:
Practice Address - Street 1:910 N 5TH ST
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-3254
Practice Address - Country:US
Practice Address - Phone:229-271-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA65938282NW0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NW0100XHospitalsGeneral Acute Care HospitalWomen