Basic Information
| Provider Information | |||||||||
| NPI: | 1912135823 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HEALTHMONT OF GEORGIA, INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | ADEL PHYSICIANS GROUP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 706 N PARRISH AVE | ||||||||
| Address2: | |||||||||
| City: | ADEL | ||||||||
| State: | GA | ||||||||
| PostalCode: | 316201511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2298968000 | ||||||||
| FaxNumber: | 2298964277 | ||||||||
| Practice Location | |||||||||
| Address1: | 308 N PARRISH AVE | ||||||||
| Address2: | |||||||||
| City: | ADEL | ||||||||
| State: | GA | ||||||||
| PostalCode: | 316202353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2298968500 | ||||||||
| FaxNumber: | 2298968503 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2009 | ||||||||
| LastUpdateDate: | 06/30/2009 | ||||||||
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| AuthorizedOfficialLastName: | HAWLEY | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2298968000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.