Organization
CRISP REGIONAL HOSPITAL, INC
Active
Organization
CRISP REGIONAL HOSPITAL, INC
Active
Other names
Crisp Regional Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN WADE WILDER (INTERNAL AUDITOR)
(229) 276-3100
Entity
Organization
Contact information
Practice address
902 N 7TH ST, CORDELE, GA 31015-3234
(229) 276-3100
(229) 276-3297
Mailing address
902 N 7TH ST, CORDELE, GA 31015-3234
(229) 271-9686
(229) 271-9689
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
ESRD001001
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000431351A
—
GA
Enumeration date
03/08/2006
Last updated
06/12/2009
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