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General NPI Number Information
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NPI Number | 1346454162
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Entity Type | Organization
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Legal Business Name | EMERGENCY CARE AT LAKE JOY
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1118 HWY 96 WEST SUITE 1
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City | KATHLEEN
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State | GA
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Zip | 31047
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Country | US
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Telephone | 478-987-0323
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Fax | 478-987-0322
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Provider Business Mailing Address
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Address Line | 1118 HWY 96 WEST SUITE 1
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City | KATHLEEN
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State | GA
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Zip | 31047
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Country | US
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Telephone | 478-987-0323
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PATON LEE HATHCOX
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Credential | MD
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Telephone | 478-987-0323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 52744
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License Number State | GA
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