Provider Demographics
NPI:1528027240
Name:FAYETTE COMMUNITY HOSPITAL, INC.
Entity Type:Organization
Organization Name:FAYETTE COMMUNITY HOSPITAL, INC.
Other - Org Name:PIEDMONT FAYETTE HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, GOVERNMENT REIMBURSEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-271-3401
Mailing Address - Street 1:1255 HIGHWAY 54 W
Mailing Address - Street 2:PATIENT FINANCIAL SERVICES
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4526
Mailing Address - Country:US
Mailing Address - Phone:770-719-7071
Mailing Address - Fax:770-719-7092
Practice Address - Street 1:1255 HIGHWAY 54 W
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4526
Practice Address - Country:US
Practice Address - Phone:770-719-7071
Practice Address - Fax:770-719-7092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056-550282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACG7492OtherMEDICARE RAIL ROAD PART B
GA00755323AMedicaid
GACG7492OtherMEDICARE RAIL ROAD PART B
GA110215Medicare Oscar/Certification