MEDICARE: FAYETTE COMMUNITY HOSPITAL, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	056-550	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CG7492	OTHER	GA	MEDICARE RAIL ROAD PART B

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528027240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAYETTE COMMUNITY HOSPITAL, INC.

Provider Business Mailing Address
First Line	:	1255 HIGHWAY 54 W
Second Line	:	PATIENT FINANCIAL SERVICES
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-4526
Country	:	US
Telephone Number	:	770-719-7071
Fax Number	:	770-719-7092

Provider Business Practice Location Address
First Line	:	1255 HIGHWAY 54 W
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-4526
Country	:	US
Telephone Number	:	770-719-7071
Fax Number	:	770-719-7092

Authorized Official
Title or Position	:	VP, GOVERNMENT REIMBURSEMENT
Name	:	MR. ROBERT C CROSS
Credential	:
Telephone Number	:	470-271-3401

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	02/26/2024

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Directions to “FAYETTE COMMUNITY HOSPITAL, INC. ” Practice Location

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