| Organization Name: | BACCHUS OPERATIONS GROUP, INC. |
| NPI Number: | 1518026202 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PHILIP H EASTMAN (CHIEF EXECUTIVE OFFICER) |
| Mailing Address: | 509 Sumter Street Montezuma |
| State: | GA US |
| Postal Code: | 310631733 |
| Phone Number: | 4784723100 |
| Fax Number: | 4784722412 |
| NPI Enumeration Date: | 12/08/2006 |
| NPI Last Update Date: | 03/23/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | 094-391 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |