Provider Demographics
NPI:1831295716
Name:SATILLA HEALTH MANAGEMENT INC
Entity Type:Organization
Organization Name:SATILLA HEALTH MANAGEMENT INC
Other - Org Name:SATILLA CONVENIENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:TRIMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-283-3030
Mailing Address - Street 1:1921 ALICE ST
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-6200
Mailing Address - Country:US
Mailing Address - Phone:912-283-5616
Mailing Address - Fax:912-287-0788
Practice Address - Street 1:1921 ALICE ST
Practice Address - Street 2:SUITE 4A
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-6200
Practice Address - Country:US
Practice Address - Phone:912-283-5616
Practice Address - Fax:912-287-0788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3652Medicare PIN