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General NPI Number Information
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NPI Number | 1386616555
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE GEORGIA HOSPITAL COMPANY LLC
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Dates
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Enumeration Date | 02/02/2006
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Last Update Date | 09/03/2020
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Provider Practice Location Address
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Address Line | 2855 OLD HIGHWAY 5
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City | BLUE RIDGE
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State | GA
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Zip | 30513-6248
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Country | US
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Telephone | 706-632-3711
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Fax | 760-632-7216
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Provider Business Mailing Address
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Address Line | PO BOX 198161
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City | ATLANTA
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State | GA
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Zip | 30384-8161
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SVP FINANCE OPERATIONS/AO
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Name | RANDY MICHAEL COOPER
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Credential |
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Telephone | 615-221-3840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 275N00000X
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Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
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License Number | 055-452
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License Number State | GA
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