Organization
EARLY MEMORIAL HOSPITAL
Active
Other names
Blakely Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES D HIGHTOWER JR. (CHIEF FINANCIAL OFFICER)
(229) 228-2853
Entity
Organization
Contact information
Practice address
11168 COLUMBIA ST, SUITE B, BLAKELY, GA 39823-3474
(229) 723-4313
(229) 723-3734
Mailing address
920 CAIRO RD, THOMASVILLE, GA 31792-4255
(229) 227-5500
(229) 227-5505
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
4945
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000635I
—
GA
01
—
11D0265994
CLIA
—
Enumeration date
07/05/2006
Last updated
12/08/2009
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