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
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