NPI 1013211564

Grady Health System

Organisation Critical Access Hospital Fayetteville, GA

Practice location

Address: 180 Victoria Dr, Fayetteville, GA 30214-1163
Phone: (404) 379-7052

Authorised official

Name: Latoya Booth Wise
Title: Anesthetist
Phone: (404) 379-7052

Registered specialties

Critical Access Hospital Primary

Hospitals Taxonomy 282NC0060X Licence 161834 (GA)

Other General Acute Care Hospital providers in Georgia →

Registry record

NPI: 1013211564
Entity type: Organization
NPI issued: 26 Dec 2010
Record last updated: 26 Dec 2010

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.