Provider Demographics
NPI:1407311939
Name:HOSPITAL AUTHORITY OF WASHINGTON COUNTY
Entity Type:Organization
Organization Name:HOSPITAL AUTHORITY OF WASHINGTON COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DRIGGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-289-1303
Mailing Address - Street 1:501 SPARTA RD STE D
Mailing Address - Street 2:
Mailing Address - City:SANDERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31082-1315
Mailing Address - Country:US
Mailing Address - Phone:478-552-3441
Mailing Address - Fax:478-552-3847
Practice Address - Street 1:501 SPARTA RD STE D
Practice Address - Street 2:
Practice Address - City:SANDERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31082-1315
Practice Address - Country:US
Practice Address - Phone:478-552-3441
Practice Address - Fax:478-552-3847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty