Provider Demographics
NPI:1487897674
Name:DOCTORS HOSPICE OF GEORGIA, INC
Entity type:Organization
Organization Name:DOCTORS HOSPICE OF GEORGIA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MCHUGH
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:706-307-1400
Mailing Address - Street 1:3660 HOWELL FERRY RD
Mailing Address - Street 2:BUILDING B
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-3178
Mailing Address - Country:US
Mailing Address - Phone:706-307-1400
Mailing Address - Fax:770-586-5108
Practice Address - Street 1:1008 HIGHWAY 54
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-0000
Practice Address - Country:US
Practice Address - Phone:706-307-1400
Practice Address - Fax:770-538-5108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-17
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067-3705-H251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA067-3705-HOtherSTATE OF GEORGIA