Basic Information
| Provider Information | |||||||||
| NPI: | 1760651665 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PIEDMONT FAYETTE HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1255 HIGHWAY 54 W | ||||||||
| Address2: | HEART FAILURE CENTER | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302144526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707196747 | ||||||||
| FaxNumber: | 7707196059 | ||||||||
| Practice Location | |||||||||
| Address1: | 1255 HIGHWAY 54 W | ||||||||
| Address2: | HEART FAILURE CENTER | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302144526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707196747 | ||||||||
| FaxNumber: | 7707196059 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2008 | ||||||||
| LastUpdateDate: | 02/25/2008 | ||||||||
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| AuthorizedOfficialLastName: | GOODING | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
| AuthorizedOfficialMiddleName: | ELAINE | ||||||||
| AuthorizedOfficialTitleorPosition: | APRN/HEART FAILURE CENTER | ||||||||
| AuthorizedOfficialTelephone: | 7707166747 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | APRN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 281P00000X | RN 174056 NP | GA | N | Hospitals | Chronic Disease Hospital | 281P00000X | RN174056 NP | GA | Y | Hospitals | Chronic Disease Hospital |
No ID Information.