Provider Demographics
NPI:1811571003
Name:STEPHENS COUNTY HOSPITAL PHYSICIAN GROUP, LLC
Entity Type:Organization
Organization Name:STEPHENS COUNTY HOSPITAL PHYSICIAN GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:HESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-369-9400
Mailing Address - Street 1:115 ROCK QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-8734
Mailing Address - Country:US
Mailing Address - Phone:706-282-5815
Mailing Address - Fax:706-898-5716
Practice Address - Street 1:115 ROCK QUARRY RD
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-8734
Practice Address - Country:US
Practice Address - Phone:706-282-5815
Practice Address - Fax:706-898-5716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty