Eisenhower Army Medical Center

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

EISENHOWER ARMY MEDICAL CENTER

Practice address

300 W Hospital Road
Eisenhower Army Medical Center Attn Credentials
Fort Gordon, GA 30907

Phone

(706) 787-2720

Fax

(706) 787-8276

NPI assigned

Dec 8, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Eugene D. Beverly

Title

Physician Assistant

Phone

(706) 787-5170

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1154480846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3126 FIELDSTONE CIRCLE",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "30907",
            "telephone_number": "706-860-0867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 W HOSPITAL ROAD",
            "address_2": "EISENHOWER ARMY MEDICAL CENTER ATTN CREDENTIALS",
            "city": "FORT GORDON",
            "state": "GA",
            "postal_code": "30907",
            "telephone_number": "706-787-2720",
            "fax_number": "706-787-8276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EISENHOWER ARMY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BEVERLY",
        "authorized_official_first_name": "EUGENE",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "PHYSICIAN ASSISTANT",
        "authorized_official_telephone_number": "706-787-5170",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nichole Eckrich
• Donald L. Edwards, PA-C
• Jan Parisot Edwards, RN,BSN,OCN
• Tracy L Eichel, MD
• Eisenhower Army Med Cen
• Eisenhower Army Medical Center
• Eisenhower Army Medical Center
• Eisenhower Army Medical Center
• Eisenhower Army Medical Center
• Eisenhower Army Medical Center

• All providers in Fort Gordon, GA
• Primary Care Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.