1174864417 NPI number — HOSPITAL AUTHORITY OF VALDOSTA AND LOWNDES COUNTY, GEORGIA

Table of content: (NPI 1174864417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174864417 NPI number — HOSPITAL AUTHORITY OF VALDOSTA AND LOWNDES COUNTY, GEORGIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSPITAL AUTHORITY OF VALDOSTA AND LOWNDES COUNTY, GEORGIA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SGMC BERRIEN CAMPUS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174864417
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALDOSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31603-0009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-433-8600
Provider Business Mailing Address Fax Number:
229-484-8778

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1221 E MCPHERSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31639-2326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-543-7100
Provider Business Practice Location Address Fax Number:
229-543-1724
Provider Enumeration Date:
03/12/2013

Additional Information

Authorized Official

Authorized Official Last Name:
HODGES
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
229-259-4140

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X , with the licence number:  010691 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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