Healthcare Provider Details

I. General information

NPI: 1548501000
Provider Name (Legal Business Name): BETHANY HOSPICE AND PALLIATIVE CARE OF COASTAL GEORGIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2013
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 S DUVAL ST
CLAXTON GA
30417-2029
US

IV. Provider business mailing address

135 GEMINI CIR STE 202
BIRMINGHAM AL
35209-5842
US

V. Phone/Fax

Practice location:
  • Phone: 912-739-0058
  • Fax: 912-739-0350
Mailing address:
  • Phone: 912-739-0058
  • Fax: 912-739-0350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number054-0285-H
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number054-0285-H
License Number StateGA

VIII. Authorized Official

Name: MR. CHRISTOPHER SMITH
Title or Position: CEO
Credential:
Phone: 205-949-0400