Provider Demographics
NPI:1689736282
Name:THE HOSPITAL AUTHORITY OF HABERSHAM COUNTY
Entity Type:Organization
Organization Name:THE HOSPITAL AUTHORITY OF HABERSHAM COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-754-3113
Mailing Address - Street 1:PO BOX 1629
Mailing Address - Street 2:
Mailing Address - City:DEMOREST
Mailing Address - State:GA
Mailing Address - Zip Code:30535-1629
Mailing Address - Country:US
Mailing Address - Phone:706-754-2161
Mailing Address - Fax:706-754-7300
Practice Address - Street 1:541 441 HISTORIC HWY N
Practice Address - Street 2:
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535-4528
Practice Address - Country:US
Practice Address - Phone:706-754-2161
Practice Address - Fax:706-754-7300
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE HOSPITAL AUTHORITY OF HABERSHAM COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-14
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4705360282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1100041Medicaid
GA00000877AMedicaid
GA000185OtherBLUE CROSS BLUE SHIELD
FL0929352-00Medicaid
SC10185BMedicaid
GA4705360OtherLICENSE #
GA00000877AMedicaid
GA110041Medicare ID - Type Unspecified