NPIMap

Organization Active NPI

Lagrange-Troup County Hospital Authority

  • Speech-Language Pathologist
  • Lagrange, GA
National Provider Identifier
1164626982
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
1092 Issued in GA
Legal business name
LAGRANGE-TROUP COUNTY HOSPITAL AUTHORITY
Practice address
1514 Vernon Rd
Lagrange, GA 30240-4131
Phone
(706) 845-3862
Fax
(706) 845-3700
NPI assigned
Jun 14, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Gerald Fulks
Title
Ceo
Phone
(706) 882-1411

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language PathologistGroup: 193400000X SINGLE SPECIALTY GROUP 235Z00000X 1092 GA Primary

Addresses

Primary practice location

1514 Vernon Rd
Lagrange, GA 30240-4131

Mailing address

1514 Vernon Rd
Lagrange, GA 30240-4131
Phone (706) 845-3862

Other names 1

  • West Georgia Health System Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Lagrange Troup County Hospital Authority2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164626982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1514 VERNON RD",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302404131",
            "telephone_number": "706-845-3862",
            "fax_number": "706-845-3700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1514 VERNON RD",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302404131",
            "telephone_number": "706-845-3862",
            "fax_number": "706-845-3700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAGRANGE-TROUP COUNTY HOSPITAL AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FULKS",
        "authorized_official_first_name": "GERALD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "706-882-1411",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "1092",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Georgia Health System",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Lagrange, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.