Provider Demographics
NPI:1396781753
Name:NEWNAN HOSPITAL
Entity type:Organization
Organization Name:NEWNAN HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:770-304-4069
Mailing Address - Street 1:PO BOX 997
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30264-0997
Mailing Address - Country:US
Mailing Address - Phone:770-252-7505
Mailing Address - Fax:770-254-3652
Practice Address - Street 1:80 JACKSON ST
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1941
Practice Address - Country:US
Practice Address - Phone:770-253-2330
Practice Address - Fax:770-254-3652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GA0079323336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1118377OtherNCPDP PROVIDER IDENTIFICATION NUMBER
GA0068844319Medicaid