Healthcare Provider Details

I. General information

NPI: 1740778828
Provider Name (Legal Business Name): THE HOSPITAL AUTHORITY OF HABERSHAM COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 01/08/2021
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 AUSTIN DR
DEMOREST GA
30535-4508
US

IV. Provider business mailing address

PO BOX 657
DEMOREST GA
30535-0657
US

V. Phone/Fax

Practice location:
  • Phone: 706-839-4092
  • Fax: 706-839-1970
Mailing address:
  • Phone: 706-839-4092
  • Fax: 706-839-1970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN TYLER WILLIAMS
Title or Position: VP OF STRATEGY AND BUSINESS DEVELOP
Credential:
Phone: 706-754-3113