Provider Demographics
NPI:1063766731
Name:GEORGIA MILITARY COLLEGE
Entity type:Organization
Organization Name:GEORGIA MILITARY COLLEGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF BUSINESS AFFAIRS/CFO
Authorized Official - Prefix:
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:MADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-387-4819
Mailing Address - Street 1:201 E GREENE ST
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-3519
Mailing Address - Country:US
Mailing Address - Phone:478-387-4712
Mailing Address - Fax:478-445-0841
Practice Address - Street 1:201 E GREENE ST
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-3519
Practice Address - Country:US
Practice Address - Phone:478-387-4712
Practice Address - Fax:478-445-0841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health