Healthcare Provider Details

I. General information

NPI: 1043287303
Provider Name (Legal Business Name): CHATUGE REGIONAL HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 01/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 BEL AIRE DR
HIAWASSEE GA
30546-3313
US

IV. Provider business mailing address

386 BEL AIRE DR
HIAWASSEE GA
30546-3313
US

V. Phone/Fax

Practice location:
  • Phone: 706-896-2231
  • Fax: 706-896-7584
Mailing address:
  • Phone: 706-896-2231
  • Fax: 706-896-7584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number11391595
License Number StateGA

VIII. Authorized Official

Name: DEBRA A SELF
Title or Position: CONTROLLER
Credential: DO
Phone: 706-439-6812