Provider Demographics
NPI:1740778828
Name:THE HOSPITAL AUTHORITY OF HABERSHAM COUNTY
Entity Type:Organization
Organization Name:THE HOSPITAL AUTHORITY OF HABERSHAM COUNTY
Other - Org Name:INTERNAL MEDICINE AND GERIATRICS-RHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF STRATEGY AND BUSINESS DEVELOP
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 657
Mailing Address - Street 2:
Mailing Address - City:DEMOREST
Mailing Address - State:GA
Mailing Address - Zip Code:30535-0657
Mailing Address - Country:US
Mailing Address - Phone:706-839-4092
Mailing Address - Fax:706-839-1970
Practice Address - Street 1:800 AUSTIN DR
Practice Address - Street 2:
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535-4508
Practice Address - Country:US
Practice Address - Phone:706-839-4092
Practice Address - Fax:706-839-1970
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE HOSPITAL AUTHORITY OF HABERSHAM COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-25
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty