# ELBERT MEMORIAL HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ELBERT MEMORIAL HOSPITAL
- **Other names:** Lake Russell Specialty Healthcare Services
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1124488291
- **Legal business name:** ELBERT MEMORIAL HOSPITAL
- **Authorized official:** BRANDON CLARY (CEO)
- **Authorized official phone:** (706) 213-2535

## Contact information

- **Practice address:** 46 LAUREL DR, ELBERTON, GA 30635-1842
- **Practice address phone:** (706) 213-2579
- **Mailing address:** 4 MEDICAL DR, ELBERTON, GA 30635-1830

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |
| 207Y00000X | Otolaryngology Physician | — | NULL | — |
| 207Y00000X | Otolaryngology Physician | — | — | — |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |

## Other

- **Enumeration date:** 03/02/2016
- **Last updated:** 03/24/2016