Provider Demographics
NPI:1114643251
Name:STEPHENS COUNTY HOSPITAL PHYSICIAN GROUP, LLC
Entity Type:Organization
Organization Name:STEPHENS COUNTY HOSPITAL PHYSICIAN GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:LOSKOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-282-5841
Mailing Address - Street 1:189 BO JAMES ST STE 105
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:GA
Mailing Address - Zip Code:30525-6199
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:189 BO JAMES ST STE 105
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:GA
Practice Address - Zip Code:30525-6199
Practice Address - Country:US
Practice Address - Phone:706-282-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEPHENS COUNTY HOSPITAL PHYSICIAN GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty