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General NPI Number Information
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NPI Number | 1013267202
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Entity Type | Organization
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Legal Business Name | HOSPITAL AUTHORITY OF LIBERTY COUNTY
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Dates
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Enumeration Date | 09/14/2012
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Last Update Date | 01/06/2022
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Provider Practice Location Address
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Address Line | 455 S.MAIN STREET STE 105
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City | HINESVILLE
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State | GA
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Zip | 31313
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Country | US
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Telephone | 912-876-0250
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Fax | 912-369-2029
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Provider Business Mailing Address
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Address Line | 455 S MAIN STREET SUITE 105
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City | HINESVILLE
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State | GA
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Zip | 31313-4354
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Country | US
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Telephone | 912-876-0250
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Fax | 912-369-2029
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Authorized Official
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Title or Position | CFO
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Name | DEREK ROZIER
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Credential |
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Telephone | 912-369-9427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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