Provider Demographics
NPI:1447423082
Name:CHATTAHOOCHEE VALLEY HOSPITAL
Entity Type:Organization
Organization Name:CHATTAHOOCHEE VALLEY HOSPITAL
Other - Org Name:LANIER MEDICAL PAVILION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-756-1050
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:267 FOB JAMES DRIVE
Mailing Address - City:VALLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36854-1000
Mailing Address - Country:US
Mailing Address - Phone:334-756-4860
Mailing Address - Fax:334-756-4866
Practice Address - Street 1:267 FOB JAMES DRIVE
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:AL
Practice Address - Zip Code:36854-5079
Practice Address - Country:US
Practice Address - Phone:334-756-4860
Practice Address - Fax:334-756-4866
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHATTAHOOCHEE VALLEY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-03
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty