Provider Demographics
NPI:1760651665
Name:PIEDMONT FAYETTE HOSPITAL
Entity Type:Organization
Organization Name:PIEDMONT FAYETTE HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN/HEART FAILURE CENTER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:GOODING
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:770-716-6747
Mailing Address - Street 1:1255 HIGHWAY 54 W
Mailing Address - Street 2:HEART FAILURE CENTER
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4526
Mailing Address - Country:US
Mailing Address - Phone:770-719-6747
Mailing Address - Fax:770-719-6059
Practice Address - Street 1:1255 HIGHWAY 54 W
Practice Address - Street 2:HEART FAILURE CENTER
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4526
Practice Address - Country:US
Practice Address - Phone:770-719-6747
Practice Address - Fax:770-719-6059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN174056 NP281P00000X
GARN 174056 NP281P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital