Basic Information
| Provider Information | |||||||||
| NPI: | 1720662919 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STEPHENS COUNTY HOSPITAL PHYSICIAN GROUP LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 163 HOSPITAL DR | ||||||||
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| City: | TOCCOA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305776820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062824200 | ||||||||
| FaxNumber: | 7068868045 | ||||||||
| Practice Location | |||||||||
| Address1: | 58 BIG A RD | ||||||||
| Address2: | |||||||||
| City: | TOCCOA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305776017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062824200 | ||||||||
| FaxNumber: | 7068868045 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2021 | ||||||||
| LastUpdateDate: | 05/12/2021 | ||||||||
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| AuthorizedOfficialLastName: | HESTER | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7062824200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.