Provider Demographics
NPI:1982818845
Name:EAST CENTRAL REGIONAL HOSPITAL
Entity Type:Organization
Organization Name:EAST CENTRAL REGIONAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACTING HOSPITAL ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:706-790-2030
Mailing Address - Street 1:100 MYRTLE BLVD
Mailing Address - Street 2:
Mailing Address - City:GRACEWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30812-1500
Mailing Address - Country:US
Mailing Address - Phone:706-790-2042
Mailing Address - Fax:
Practice Address - Street 1:100 MYRTLE BLVD
Practice Address - Street 2:
Practice Address - City:GRACEWOOD
Practice Address - State:GA
Practice Address - Zip Code:30812-1500
Practice Address - Country:US
Practice Address - Phone:706-790-2042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA121231283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital