John D. Archbold Memorial Hospital, Inc.

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

License

136-91 Issued in GA

Legal business name

JOHN D. ARCHBOLD MEMORIAL HOSPITAL, INC.

Doing business as

Coolidge Primary Care Clinic

Practice address

1034 South Pine Street
Coolidge, GA 31738

Phone

(229) 346-3511

Fax

(229) 346-3512

NPI assigned

Oct 6, 2006

Last updated

May 7, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Charles D. Hightower Jr.

Title

Cfo

Phone

(229) 228-2853

Specialties & licenses 1

Addresses

Other names 1

• Coolidge Primary Care Clinic Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210118400000",
    "number": "1114014669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 CAIRO RD",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317924255",
            "telephone_number": "229-228-8800",
            "fax_number": "229-228-8892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1034 SOUTH PINE STREET",
            "city": "COOLIDGE",
            "state": "GA",
            "postal_code": "31738",
            "telephone_number": "229-346-3511",
            "fax_number": "229-346-3512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN D. ARCHBOLD MEMORIAL HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2008-05-07",
        "status": "A",
        "authorized_official_last_name": "HIGHTOWER",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "229-228-2853",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "GA",
            "license": "136-91",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coolidge Primary Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Damon Graham Jr., LCSW
• Rebecca Marie Grave de Peralta, RN
• Sylvia Holmes
• Catherine Basford Howell, PH.D.
• Tamara A Iacampo, LCSW
• Premise Health of Georgia Medical PC (Hurst Boiler Health & Wellness Center)

• Rural Health Clinic/Center in Coolidge, GA
• Providers in Coolidge, GA by specialty
• Rural Health Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.