John D. Archbold Memorial Hospital, Inc.

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

License

ESRD001132 Issued in GA

Legal business name

JOHN D. ARCHBOLD MEMORIAL HOSPITAL, INC.

Doing business as

Mitchell County Dialysis Facility

Practice address

251 US Highway 19 N
Camilla, GA 31730-1410

Phone

(229) 336-5874

Fax

(229) 336-5878

NPI assigned

Jul 6, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Gregory S. Hembree

Title

Cfo

Phone

(229) 228-2880

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mitchell County Dialysis Facility Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• John D. Archbold Memorial Hospital, Inc.

  • Diagnostic Radiology Physician
  • Thomasville, GA
  • NPI 1841644390

  Member Of

  NPD member

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488499200000",
    "number": "1205867256",
    "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": "251 US HIGHWAY 19 N",
            "city": "CAMILLA",
            "state": "GA",
            "postal_code": "317301410",
            "telephone_number": "229-336-5874",
            "fax_number": "229-336-5878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN D. ARCHBOLD MEMORIAL HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2017-03-03",
        "status": "A",
        "authorized_official_last_name": "HEMBREE",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "229-228-2880",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "GA",
            "license": "ESRD001132",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000407327A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mitchell County Dialysis Facility",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• J Larry Pritchett O D P C
• Shenika Laverne Jackson, O.T.
• Torry Jackson
• Keith Lanel Jenkins Sr., BSW
• JHM,Inc.
• John D. Archbold Memorial Hospital, Inc.
• Brian Johnson, BA
• Jennifer Gail Johnson, PTA
• Roy Lee Johnson
• Chastertine Jones

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Camilla, GA
• Providers in Camilla, GA by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2017; 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.