| Organization Name: | PHOEBE DORMINY MEDICAL CENTER, INC. |
| NPI Number: | 1619255189 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PAIGE P WYNN (CFO) |
| Mailing Address: | 182 Perry House Rd Ste. B Fitzgerald |
| State: | GA US |
| Postal Code: | 317508721 |
| Phone Number: | 2294247263 |
| Fax Number: | 2294247281 |
| NPI Enumeration Date: | 08/01/2011 |
| NPI Last Update Date: | 11/08/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |