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General NPI Number Information
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NPI Number | 1265671457
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Entity Type | Organization
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Legal Business Name | HOSPITALIST AT FAIRVIEW PARK, LLC
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Dates
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Enumeration Date | 02/11/2009
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Last Update Date | 02/11/2009
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Provider Practice Location Address
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Address Line | 200 INDUSTRIAL BLVD
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City | DUBLIN
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State | GA
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Zip | 31021-2981
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Country | US
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Telephone | 478-274-3747
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Fax | 478-274-3663
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Provider Business Mailing Address
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Address Line | 200 INDUSTRIAL BLVD
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City | DUBLIN
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State | GA
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Zip | 31021-2981
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Country | US
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Telephone | 478-274-3747
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Fax | 478-274-3663
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Authorized Official
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Title or Position | VP
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Name | JOHN LAVERTY
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Credential |
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Telephone | 615-507-2312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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