Provider Demographics
NPI:1700278629
Name:UPSON COUNTY HOSPITAL INC
Entity Type:Organization
Organization Name:UPSON COUNTY HOSPITAL INC
Other - Org Name:UPON REGIONAL MEDICAL CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:TARRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-647-8111
Mailing Address - Street 1:PO BOX 1059
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-0027
Mailing Address - Country:US
Mailing Address - Phone:706-647-8111
Mailing Address - Fax:706-646-3258
Practice Address - Street 1:801 W GORDON ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-3426
Practice Address - Country:US
Practice Address - Phone:706-647-8111
Practice Address - Fax:706-646-3258
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UPSON COUNTY HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-02
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0101193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy