NPIMap

Organization Active NPI

Early Memorial Hospital

Doing business as Blakely Medical Group

  • Rural Health Clinic/Center
  • Blakely, GA
National Provider Identifier
1386675817
Registry record updated Dec 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
4945 Issued in GA
Legal business name
EARLY MEMORIAL HOSPITAL
Doing business as
Blakely Medical Group
Practice address
11168 Columbia St
Suite B
Blakely, GA 39823-3474
Phone
(229) 723-4313
Fax
(229) 723-3734
NPI assigned
Jul 5, 2006
Last updated
Dec 8, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2009

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
Chief Financial Officer
Phone
(229) 228-2853

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 4945 GA Primary

Addresses

Primary practice location

11168 Columbia St
Suite B
Blakely, GA 39823-3474

Mailing address

920 Cairo Rd
Thomasville, GA 31792-4255
Phone (229) 227-5500

Other identifiers 2

IdentifierTypeStateIssuer
000000635IMedicaidGA
11D0265994OtherCLIA

Other names 1

  • Blakely Medical Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Early Memorial Hospital6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260230400000",
    "number": "1386675817",
    "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": "229-227-5500",
            "fax_number": "229-227-5505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11168 COLUMBIA ST",
            "address_2": "SUITE B",
            "city": "BLAKELY",
            "state": "GA",
            "postal_code": "398233474",
            "telephone_number": "229-723-4313",
            "fax_number": "229-723-3734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EARLY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2009-12-08",
        "status": "A",
        "authorized_official_last_name": "HIGHTOWER",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "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": "4945",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000000635I",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "11D0265994",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blakely Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blakely, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2009; 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.