Provider Demographics
NPI:1023289865
Name:MURRAY MOUNTAIN MEDICAL CENTER
Entity type:Organization
Organization Name:MURRAY MOUNTAIN MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:JINRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-695-1992
Mailing Address - Street 1:PO BOX 1007
Mailing Address - Street 2:
Mailing Address - City:ETON
Mailing Address - State:GA
Mailing Address - Zip Code:30724-1007
Mailing Address - Country:US
Mailing Address - Phone:706-695-1992
Mailing Address - Fax:
Practice Address - Street 1:79 HWY 286 SUITE B
Practice Address - Street 2:
Practice Address - City:ETON
Practice Address - State:GA
Practice Address - Zip Code:30724
Practice Address - Country:US
Practice Address - Phone:706-695-1992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN149515363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7341Medicare PIN