Provider Demographics
NPI:1992776124
Name:PREMEIR HOSPICE OF GEORGIA, INC.
Entity type:Organization
Organization Name:PREMEIR HOSPICE OF GEORGIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HUDDLESTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, RN
Authorized Official - Phone:219-756-7640
Mailing Address - Street 1:PO BOX 610
Mailing Address - Street 2:
Mailing Address - City:DEMOTTE
Mailing Address - State:IN
Mailing Address - Zip Code:46310-0610
Mailing Address - Country:US
Mailing Address - Phone:219-756-7640
Mailing Address - Fax:219-756-3876
Practice Address - Street 1:500 SPRING ST SE
Practice Address - Street 2:SUITE 204
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3773
Practice Address - Country:US
Practice Address - Phone:219-756-7640
Practice Address - Fax:219-756-3876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA069-164-H251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111593Medicare ID - Type Unspecified