Healthcare Provider Details

I. General information

NPI: 1215943915
Provider Name (Legal Business Name): HOSPITAL AUTHORITY OF JEFFERSON COUNTY AND THE CITY OF LOUISVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1067 PEACHTREE ST
LOUISVILLE GA
30434-1558
US

IV. Provider business mailing address

1067 PEACHTREE ST
LOUISVILLE GA
30434
US

V. Phone/Fax

Practice location:
  • Phone: 478-625-7000
  • Fax: 478-625-8907
Mailing address:
  • Phone: 478-625-7000
  • Fax: 478-625-8907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESSICA GUY
Title or Position: ASSISTANT ADMINISTRATOR
Credential:
Phone: 478-625-7000