Provider Demographics
NPI:1033359195
Name:UHS OF SUMMITRIDGE, LLC
Entity Type:Organization
Organization Name:UHS OF SUMMITRIDGE, LLC
Other - Org Name:SUMMITRIDGE HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-442-5942
Mailing Address - Street 1:250 SCENIC HWY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-5675
Mailing Address - Country:US
Mailing Address - Phone:678-442-5900
Mailing Address - Fax:678-442-5909
Practice Address - Street 1:250 SCENIC HWY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-5675
Practice Address - Country:US
Practice Address - Phone:678-442-5900
Practice Address - Fax:678-442-5909
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UHS OF SUMMITRIDGE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0676482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty