Provider Demographics
NPI:1710215355
Name:HIDDEN VALLEY MEDICAL CENTER INC
Entity Type:Organization
Organization Name:HIDDEN VALLEY MEDICAL CENTER INC
Other - Org Name:APPALACHIAN PHYSICIANS GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR PHYSICIAN OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-628-6038
Mailing Address - Street 1:PO BOX 689022
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-9022
Mailing Address - Country:US
Mailing Address - Phone:615-628-6038
Mailing Address - Fax:615-465-3007
Practice Address - Street 1:4799 BLUE RIDGE DR
Practice Address - Street 2:SUITE 104
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-3240
Practice Address - Country:US
Practice Address - Phone:706-258-4868
Practice Address - Fax:706-258-1165
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HIDDEN VALLEY MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-19
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003108331AMedicaid
GA003108331AMedicaid