Provider Demographics
NPI:1942203633
Name:PIEDMONT NEWTON HOSPITAL, INC.
Entity Type:Organization
Organization Name:PIEDMONT NEWTON HOSPITAL, INC.
Other - Org Name:PIEDMONT NEWTON HOSPITAL HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-788-9403
Mailing Address - Street 1:4168 TATE STREET NE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2559
Mailing Address - Country:US
Mailing Address - Phone:770-788-9403
Mailing Address - Fax:770-788-9406
Practice Address - Street 1:4168 TATE STREET NE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2559
Practice Address - Country:US
Practice Address - Phone:770-788-9403
Practice Address - Fax:770-788-9406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA107-196251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00742255AMedicaid
GA117113Medicare Oscar/Certification