Provider Demographics
NPI:1851362263
Name:BLUE RIDGE GEORGIA HOSPITAL COMPANY LLC
Entity Type:Organization
Organization Name:BLUE RIDGE GEORGIA HOSPITAL COMPANY LLC
Other - Org Name:FANNIN REGIONAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:QUALITY HIM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:N
Authorized Official - Last Name:EATON
Authorized Official - Suffix:
Authorized Official - Credentials:RHIA
Authorized Official - Phone:706-632-4270
Mailing Address - Street 1:PO BOX 198161
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-8161
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2855 OLD HIGHWAY 5
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-6248
Practice Address - Country:US
Practice Address - Phone:706-632-3711
Practice Address - Fax:706-632-7216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055-452282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1100189Medicaid
182266100OtherW/C
TN0053487Medicaid
TN0110189Medicaid
000157OtherBCBS
053487OtherBC TN
GA110189Medicare Oscar/Certification