Provider Demographics
NPI:1285217414
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:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:HESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-369-9400
Mailing Address - Street 1:1025 FALLS RD
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-2422
Mailing Address - Country:US
Mailing Address - Phone:706-282-4200
Mailing Address - Fax:706-886-8045
Practice Address - Street 1:1025 FALLS RD
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-2422
Practice Address - Country:US
Practice Address - Phone:706-282-4200
Practice Address - Fax:706-886-8045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Single Specialty