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Organization
EISENHOWER ARMY MEDICAL CENTER
Active
Organization
EISENHOWER ARMY MEDICAL CENTER
Active
Parent organization
EISENHOWER ARMY MEDICAL CENTER
Other names
CONNELLY HEALTH CLINIC
Organization subpart
Yes
Provider details
NPI number
Legal business name
EISENHOWER ARMY MEDICAL CENTER
Authorized official
MARVIN PRIMOS (UBO MANAGER)
(706) 787-7204
Entity
Organization
Contact information
Practice address
29709 B STREET, FORT GORDON, GA 30905-5741
(706) 787-5811
Mailing address
300 W HOSPITAL RD BLDG W, ATTN MCHF-PAD, FORT GORDON, GA 30905-5741
(706) 787-1125
Taxonomy
Speciality
Code
Description
License number
State
261QM1100X
Military/U.S. Coast Guard Outpatient Clinic/Center
Primary
—
NULL
332000000X
Military/U.S. Coast Guard Pharmacy
—
NULL
Other
Enumeration date
10/23/2006
Last updated
01/31/2013
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