Provider Demographics
NPI:1720589328
Name:PIEDMONT WALTON HOSPITAL INC
Entity Type:Organization
Organization Name:PIEDMONT WALTON HOSPITAL INC
Other - Org Name:
Other - Org Type:
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 1:2727 PACES FERRY RD SE STE 2-920
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-4053
Mailing Address - Country:US
Mailing Address - Phone:770-267-8461
Mailing Address - Fax:
Practice Address - Street 1:2151 W SPRING ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-3202
Practice Address - Country:US
Practice Address - Phone:770-267-8461
Practice Address - Fax:770-267-1888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-28
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA147-613282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000020677AMedicaid