Healthcare Provider Details

I. General information

NPI: 1790781821
Provider Name (Legal Business Name): PIEDMONT HENRY HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 08/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 HOSPITAL DR
STOCKBRIDGE GA
30281-7384
US

IV. Provider business mailing address

1050 HOSPITAL DR
STOCKBRIDGE GA
30281-7384
US

V. Phone/Fax

Practice location:
  • Phone: 678-604-1600
  • Fax: 678-604-1601
Mailing address:
  • Phone: 678-604-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number10751648
License Number StateGA

VIII. Authorized Official

Name: MR. CHARLES F SCOTT
Title or Position: PRESIDENT/CEO
Credential:
Phone: 678-604-1001