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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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