Organization
SUMTER REGIONAL HOSPITAL
Active
Organization
SUMTER REGIONAL HOSPITAL
Active
Other names
Ellaville Primary Medicine Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARYANNE SHEPHERD N. P. (DIRECTOR)
(229) 937-5321
Entity
Organization
Contact information
Practice address
72 S. BROAD ST., ELLAVILLE, GA 31806
(229) 937-5321
(229) 937-2232
Mailing address
PO BOX 65, ELLAVILLE, GA 31806-0065
(229) 937-5321
(229) 937-2232
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00000019F
—
GA
Enumeration date
12/26/2006
Last updated
08/22/2020
Update your record
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