Provider Demographics
NPI:1194712083
Name:TMC/HIGGINS GENERAL HOSPITAL
Entity type:Organization
Organization Name:TMC/HIGGINS GENERAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHERSETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-836-9697
Mailing Address - Street 1:200 ALLEN MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:GA
Mailing Address - Zip Code:30110-2012
Mailing Address - Country:US
Mailing Address - Phone:770-824-2000
Mailing Address - Fax:770-824-2309
Practice Address - Street 1:200 ALLEN MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:GA
Practice Address - Zip Code:30110-2012
Practice Address - Country:US
Practice Address - Phone:770-824-2000
Practice Address - Fax:770-824-2309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000000945AMedicaid
GA300034095DMedicaid
GA300034095EMedicaid
GAHOSP216Medicare Oscar/Certification
GA300034095EMedicaid