Organization
THE HOSPITAL AUTHORITY OF HABERSHAM COUNTY
Active
Parent organization
THE HOSPITAL AUTHORITY OF HABERSHAM COUNTY
Other names
PrimeCare
Organization subpart
Yes
Provider details
NPI number
Legal business name
THE HOSPITAL AUTHORITY OF HABERSHAM COUNTY
Authorized official
MR. JAMES A PETERSON (SR. VP OF FINANCE)
(706) 754-3113
Entity
Organization
Contact information
Practice address
541 HISTORIC HWY 441 N, DEMOREST, GA 30535-4528
(706) 754-2273
(706) 754-7300
Mailing address
396 HISTORIC HIGHWAY 441 N, DEMOREST, GA 30535
(706) 754-2273
(706) 754-7300
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4705360
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0930
HEALTHSTAR PROVIDER #
GA
01
—
11D0944659
CLIA #
GA
01
—
231
COVENANT ADMINISTRATORS #
GA
01
—
2466081
PHOENIX HOME LIFE
GA
01
—
DA0733
RAILROAD MCR PROVIDER #
GA
Enumeration date
03/13/2007
Last updated
03/26/2014
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