Healthcare Provider Details

I. General information

NPI: 1073494795
Provider Name (Legal Business Name): STEPHENS COUNTY HOSPITAL PHYSICIAN GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 INDIAN TRAIL ROAD
TOCCOA GA
30577-7918
US

IV. Provider business mailing address

323 INDIAN TRAIL ROAD
TOCCOA GA
30577-7918
US

V. Phone/Fax

Practice location:
  • Phone: 706-282-4200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
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