1417944075 NPI number — CHATTAHOOCHEE VALLEY HOSPITAL SOCIETY

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 1417944075 NPI number — CHATTAHOOCHEE VALLEY HOSPITAL SOCIETY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHATTAHOOCHEE VALLEY HOSPITAL SOCIETY
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:
1417944075
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 475
Provider Second Line Business Mailing Address:
5700 CHIPLEY VILLAGE
Provider Business Mailing Address City Name:
PINE MOUNTAIN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31822-0475
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-663-0988
Provider Business Mailing Address Fax Number:
706-663-0687

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
US HWY 27 AND 354
Provider Second Line Business Practice Location Address:
5700 CHIPLEY VILLAGE
Provider Business Practice Location Address City Name:
PINE MOUNTAIN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31822-0475
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-663-0988
Provider Business Practice Location Address Fax Number:
706-663-0687
Provider Enumeration Date:
09/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
VEAL
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
DIRECTOR OF HOME HEALTH
Authorized Official Telephone Number:
334-756-1950

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  072-261-H , 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)





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