Healthcare Provider Details

I. General information

NPI: 1073516621
Provider Name (Legal Business Name): HIDDEN VALLEY MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 10/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 RIVERSTONE VIS STE 300
BLUE RIDGE GA
30513-6683
US

IV. Provider business mailing address

101 RIVERSTONE VIS STE 300
BLUE RIDGE GA
30513-6683
US

V. Phone/Fax

Practice location:
  • Phone: 706-946-4206
  • Fax: 706-946-4289
Mailing address:
  • Phone: 706-946-4206
  • Fax: 706-946-4289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SOPHIA ARWOOD
Title or Position: DIRECTOR PHYSICIAN OPERATIONS
Credential:
Phone: 615-628-6038