Provider Demographics
NPI:1255194767
Name:JOHN D ARCHBOLD MEMORIAL HOSPITAL, INC
Entity type:Organization
Organization Name:JOHN D ARCHBOLD MEMORIAL HOSPITAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AVP
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-228-2229
Mailing Address - Street 1:PO BOX 620
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31799-0620
Mailing Address - Country:US
Mailing Address - Phone:229-228-2229
Mailing Address - Fax:
Practice Address - Street 1:2705 E PINETREE BLVD STE G
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-4876
Practice Address - Country:US
Practice Address - Phone:229-584-2378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy