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NPI Code Detail

MEDICARE: BLUE RIDGE GEORGIA HOSPITAL COMPANY LLC

MEDICARE: BLUE RIDGE GEORGIA HOSPITAL COMPANY LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1275N00000XMedicare Defined Swing Bed Hospital Unit055-452GA

General Provider Information

NPI Number : 1386616555
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLUE RIDGE GEORGIA HOSPITAL COMPANY LLC
Provider Business Mailing Address
First Line : PO BOX 198161
Second Line :
City : ATLANTA
State : GA
Zip : 30384-8161
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2855 OLD HIGHWAY 5
Second Line :
City : BLUE RIDGE
State : GA
Zip : 30513-6248
Country : US
Telephone Number : 706-632-3711
Fax Number : 760-632-7216
Authorized Official
Title or Position : SVP FINANCE OPERATIONS/AO
Name : RANDY MICHAEL COOPER
Credential :
Telephone Number : 615-221-3840
Provider Enumeration Date : 02/02/2006
Last Update Date : 09/03/2020

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Directions to “BLUE RIDGE GEORGIA HOSPITAL COMPANY LLC ” Practice Location

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