# COFFEE REGIONAL MEDICAL CENTER, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Coffee Regional Medical Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760419527
- **Authorized official:** MRS. VICKI LEWIS (PRESIDENT/CEO)
- **Authorized official phone:** (912) 384-1900

## Contact information

- **Practice address:** 1101 OCILLA ROAD, DOUGLAS, GA 31533-2207
- **Practice address phone:** (912) 384-1900
- **Practice address fax:** (912) 389-2112
- **Mailing address:** P O BOX 1227, DOUGLAS, GA 31534-1227
- **Mailing address phone:** (912) 384-1900
- **Mailing address fax:** (912) 389-2112

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 282N00000X | General Acute Care Hospital | 034490 | GA | Yes |

## Other

- **Enumeration date:** 06/27/2006
- **Last updated:** 12/17/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00000448A | — | GA |