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General NPI Number Information
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NPI Number | 1487897674
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Entity Type | Organization
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Legal Business Name | DOCTORS HOSPICE OF GEORGIA, INC
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Dates
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Enumeration Date | 04/17/2009
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Last Update Date | 04/17/2009
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Provider Practice Location Address
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Address Line | 1008 HIGHWAY 54
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City | FAYETTEVILLE
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State | GA
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Zip | 30215-0000
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Country | US
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Telephone | 706-307-1400
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Fax | 770-538-5108
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Provider Business Mailing Address
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Address Line | 3660 HOWELL FERRY RD BUILDING B
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City | DULUTH
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State | GA
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Zip | 30096-3178
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Country | US
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Telephone | 706-307-1400
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Fax | 770-586-5108
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Authorized Official
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Title or Position | PRESIDENT
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Name | KEVIN JOSEPH MCHUGH
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Credential | RN, MSN
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Telephone | 706-307-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 067-3705-H
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License Number State | GA
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