Basic Information
| Provider Information | |||||||||
| NPI: | 1285217414 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STEPHENS COUNTY HOSPITAL PHYSICIAN GROUP, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1025 FALLS RD | ||||||||
| Address2: | |||||||||
| City: | TOCCOA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305772422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062824200 | ||||||||
| FaxNumber: | 7068868045 | ||||||||
| Practice Location | |||||||||
| Address1: | 1025 FALLS RD | ||||||||
| Address2: | |||||||||
| City: | TOCCOA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305772422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062824200 | ||||||||
| FaxNumber: | 7068868045 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2021 | ||||||||
| LastUpdateDate: | 05/05/2021 | ||||||||
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| AuthorizedOfficialLastName: | HESTER | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9123699400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WW0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | Wound Care |
No ID Information.