Organization
HOSPITAL AUTHORITY OF LIBERTY COUNTY
Active
Other names
LIBERTY FAMILY MEDICINE
Organization subpart
No
Provider details
NPI number
Authorized official
DEREK ROZIER (CFO)
(912) 369-9427
Entity
Organization
Contact information
Practice address
455 S.MAIN STREET STE 104, HINESVILLE, GA 31313
(912) 876-5644
(912) 408-3457
Mailing address
455 S MAIN STREET, SUITE 104, HINESVILLE, GA 31313-4354
(912) 876-5644
(912) 877-6341
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
065972
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
065972
STATE LICENSE
GA
Enumeration date
06/15/2011
Last updated
01/06/2022
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