Healthcare Provider Details

I. General information

NPI: 1760251367
Provider Name (Legal Business Name): STEPHENS COUNTY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2023
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 HOSPITAL DR
TOCCOA GA
30577-6820
US

IV. Provider business mailing address

163 HOSPITAL DR
TOCCOA GA
30577-6820
US

V. Phone/Fax

Practice location:
  • Phone: 706-282-4362
  • Fax: 706-282-4458
Mailing address:
  • Phone: 706-282-4362
  • Fax: 706-282-4458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
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: THOMAS LOSKOSKI
Title or Position: CEO
Credential:
Phone: 706-282-5841