1346373180 NPI number — THE HOSPITAL AUTHORITY OF HABERSHAM COUNTY

Table of Contents

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:
Provider Other Organization Name Type Code:
6
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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