MEDICARE: PIEDMONT NEWTON HOSPITAL, INC.

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
1	251E00000X	Home Health Agency	107-196	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942203633
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIEDMONT NEWTON HOSPITAL, INC.

Provider Business Mailing Address
First Line	:	4168 TATE STREET NE
Second Line	:
City	:	COVINGTON
State	:	GA
Zip	:	30014-2559
Country	:	US
Telephone Number	:	770-788-9403
Fax Number	:	770-788-9406

Provider Business Practice Location Address
First Line	:	4168 TATE STREET NE
Second Line	:
City	:	COVINGTON
State	:	GA
Zip	:	30014-2559
Country	:	US
Telephone Number	:	770-788-9403
Fax Number	:	770-788-9406

Authorized Official
Title or Position	:	DIRECTOR/ADMINISTRATOR
Name	:	MR. BRAD COLLIER
Credential	:
Telephone Number	:	770-788-9403

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	05/03/2016

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