Provider Demographics
NPI:1700052453
Name:CHATTAHOOCHEE VALLEY HOSPITAL SOCIETY
Entity Type:Organization
Organization Name:CHATTAHOOCHEE VALLEY HOSPITAL SOCIETY
Other - Org Name:LANIER PRIMARY CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-756-4860
Mailing Address - Street 1:11 MEDICAL PARK
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36854-3665
Mailing Address - Country:US
Mailing Address - Phone:334-756-4860
Mailing Address - Fax:334-756-4866
Practice Address - Street 1:11 MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:AL
Practice Address - Zip Code:36854-3665
Practice Address - Country:US
Practice Address - Phone:334-756-4860
Practice Address - Fax:334-756-4866
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHATTAHOOCHEE VALLEY HOSPITAL SOCIETY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALQ48292Medicare UPIN
ALF79815Medicare UPIN