Provider Demographics
NPI:1225218837
Name:HOSPITALMD OF SPARTA-IP, INC
Entity Type:Organization
Organization Name:HOSPITALMD OF SPARTA-IP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:BURNETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-364-1422
Mailing Address - Street 1:200 WESTPARK DR
Mailing Address - Street 2:SUITE 325
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-3534
Mailing Address - Country:US
Mailing Address - Phone:770-632-6981
Mailing Address - Fax:770-631-8473
Practice Address - Street 1:818 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:IL
Practice Address - Zip Code:62286-1820
Practice Address - Country:US
Practice Address - Phone:618-443-2177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty