Healthcare Provider Details

I. General information

NPI: 1649853862
Provider Name (Legal Business Name): STEPHENS COUNTY HOSPITAL PHYSICIAN GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 FALLS RD
TOCCOA GA
30577-1631
US

IV. Provider business mailing address

218 FALLS RD
TOCCOA GA
30577-1631
US

V. Phone/Fax

Practice location:
  • Phone: 706-282-5840
  • Fax: 706-898-5344
Mailing address:
  • Phone: 706-282-5840
  • Fax: 706-898-5344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MICHAEL S HESTER
Title or Position: CEO
Credential:
Phone: 912-369-9400