Provider Demographics
NPI:1386670834
Name:PUTNAM GENERAL HOSPITAL AUTHORITY
Entity type:Organization
Organization Name:PUTNAM GENERAL HOSPITAL AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:CULBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-923-2006
Mailing Address - Street 1:101 LAKE OCONEE PKWY
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-6054
Mailing Address - Country:US
Mailing Address - Phone:706-923-2002
Mailing Address - Fax:706-485-2702
Practice Address - Street 1:101 LAKE OCONEE PKWY
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-6054
Practice Address - Country:US
Practice Address - Phone:706-923-2002
Practice Address - Fax:706-485-2702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA117-216282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA336OtherBC/BS PROVIDER NUMBER
GA00001537AMedicaid
GA0006210575OtherAETNA PROVIDER NUMBER
GA00001537AMedicaid