1346373180 NPI number — THE HOSPITAL AUTHORITY OF HABERSHAM COUNTY

Table of content: (NPI 1346373180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346373180 NPI number — THE HOSPITAL AUTHORITY OF HABERSHAM COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE HOSPITAL AUTHORITY OF HABERSHAM COUNTY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PRIMECARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346373180
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
396 HISTORIC HIGHWAY 441 N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEMOREST
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-754-2273
Provider Business Mailing Address Fax Number:
706-754-7300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
541 HISTORIC HWY 441 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEMOREST
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30535-4528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-754-2273
Provider Business Practice Location Address Fax Number:
706-754-7300
Provider Enumeration Date:
03/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PETERSON
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
A
Authorized Official Title or Position:
SR. VP OF FINANCE
Authorized Official Telephone Number:
706-754-3113

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  4705360 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11D0944659 . This is a "CLIA #" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 231 . This is a "COVENANT ADMINISTRATORS #" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 2466081 . This is a "PHOENIX HOME LIFE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 0930 . This is a "HEALTHSTAR PROVIDER #" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: DA0733 . This is a "RAILROAD MCR PROVIDER #" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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