Provider Demographics
NPI:1891925608
Name:EFFINGHAM HOSPITAL, INC.
Entity Type:Organization
Organization Name:EFFINGHAM HOSPITAL, INC.
Other - Org Name:EFFINGHAM FAMILY MEDICINE AT PORT WENTWORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRANCINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER-WITT
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MBA, CNHA
Authorized Official - Phone:912-754-0142
Mailing Address - Street 1:459 HIGHWAY 119 SOUTH
Mailing Address - Street 2:ATTN.: ALIA ALLEN/MEDICAL STAFF OFFICE
Mailing Address - City:SPRINGFIELD
Mailing Address - State:GA
Mailing Address - Zip Code:31329
Mailing Address - Country:US
Mailing Address - Phone:912-754-0175
Mailing Address - Fax:912-754-6395
Practice Address - Street 1:7306 GA HIGHWAY 21
Practice Address - Street 2:STE 105
Practice Address - City:PORT WENTWORTH
Practice Address - State:GA
Practice Address - Zip Code:31407-9275
Practice Address - Country:US
Practice Address - Phone:912-966-2575
Practice Address - Fax:912-966-0906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAHOSP150OtherMEDICARE