Organization
DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL DISABILITIES
Active
Other names
East Central Regional Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL BROCK (REGIONAL HOSPITAL ADMINISTRATOR)
(706) 790-2030
Entity
Organization
Contact information
Practice address
100 MYRTLE BLVD, GRACEWOOD, GA 30812-1500
(706) 790-2496
(706) 790-2340
Mailing address
100 MYRTLE BLVD, GRACEWOOD, GA 30812-1500
(706) 790-2030
(706) 790-2025
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
PHH004147
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000355737A
—
GA
01
—
1110395
NCPDP
GA
Enumeration date
01/15/2010
Last updated
05/20/2015
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