Provider Demographics
NPI:1063953149
Name:EFFINGHAM ORTHOPEDIC PRACTICE LLC
Entity type:Organization
Organization Name:EFFINGHAM ORTHOPEDIC PRACTICE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO & NURSING HOME ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANCINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER-WITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-754-0142
Mailing Address - Street 1:459 HIGHWAY 119 S
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:GA
Mailing Address - Zip Code:31329-3021
Mailing Address - Country:US
Mailing Address - Phone:912-754-0175
Mailing Address - Fax:912-754-6395
Practice Address - Street 1:613 TOWNE PARK DR W
Practice Address - Street 2:SUITE 303-304
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-5182
Practice Address - Country:US
Practice Address - Phone:912-355-6615
Practice Address - Fax:912-351-0645
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EFFINGHAM ORTHOPEDIC PRACTICE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty