Provider Demographics
NPI:1609553965
Name:HOMETOWN OCCUPATIONAL MEDICINE
Entity Type:Organization
Organization Name:HOMETOWN OCCUPATIONAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BREANNA
Authorized Official - Middle Name:DOROTHY
Authorized Official - Last Name:BASSETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-972-0403
Mailing Address - Street 1:89 SANDY RUN RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:BONARE
Mailing Address - State:GA
Mailing Address - Zip Code:31005
Mailing Address - Country:US
Mailing Address - Phone:478-412-4774
Mailing Address - Fax:478-412-4775
Practice Address - Street 1:89 SANDY RUN RD
Practice Address - Street 2:SUITE 500
Practice Address - City:BONARE
Practice Address - State:GA
Practice Address - Zip Code:31005
Practice Address - Country:US
Practice Address - Phone:478-412-4774
Practice Address - Fax:478-412-4775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty