Provider Demographics
NPI:1013267202
Name:HOSPITAL AUTHORITY OF LIBERTY COUNTY
Entity Type:Organization
Organization Name:HOSPITAL AUTHORITY OF LIBERTY COUNTY
Other - Org Name:LIBERTY PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:ROZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-369-9427
Mailing Address - Street 1:455 S MAIN STREET
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-4354
Mailing Address - Country:US
Mailing Address - Phone:912-876-0250
Mailing Address - Fax:912-369-2029
Practice Address - Street 1:455 S.MAIN STREET STE 105
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313
Practice Address - Country:US
Practice Address - Phone:912-876-0250
Practice Address - Fax:912-369-2029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty