Basic Information
| Provider Information | |||||||||
| NPI: | 1386954394 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JENKINS COUNTY HOSPTIAL LLC | ||||||||
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| OtherOrganizationName: | OPTIM SURGICAL ASSOCIATES - JENKINS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 E DERENNE AVE | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314056736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9126445300 | ||||||||
| FaxNumber: | 9126445260 | ||||||||
| Practice Location | |||||||||
| Address1: | 960 COLLEGE AVE | ||||||||
| Address2: | |||||||||
| City: | MILLEN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 304421634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4789821560 | ||||||||
| FaxNumber: | 4789822478 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2010 | ||||||||
| LastUpdateDate: | 07/24/2015 | ||||||||
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| AuthorizedOfficialLastName: | GUENTHNER | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | SECRETARY OF JENKINS COUNTY HOSPITA | ||||||||
| AuthorizedOfficialTelephone: | 3126278247 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | GA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.