Healthcare Provider Details

I. General information

NPI: 1699290510
Provider Name (Legal Business Name): PIEDMONT SPECIALTY HOSPITAL BILLING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2017
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1266 HIGHWAY 515 S
JASPER GA
30143-4872
US

IV. Provider business mailing address

PO BOX 102847
ATLANTA GA
30368-2847
US

V. Phone/Fax

Practice location:
  • Phone: 770-801-2500
  • Fax: 770-803-2121
Mailing address:
  • Phone: 770-801-2500
  • Fax: 770-803-2121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHRISTY AQUINO
Title or Position: DIRECTOR OF PROVIDER ENORLLMENT
Credential:
Phone: 470-271-3427