Provider Demographics
NPI:1043514557
Name:HOSPITAL AUTHORITY OF ALBANY-DOUGHERTY COUNTY GEORGIA
Entity Type:Organization
Organization Name:HOSPITAL AUTHORITY OF ALBANY-DOUGHERTY COUNTY GEORGIA
Other - Org Name:PHOEBE NORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP
Authorized Official - Prefix:MR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOUDERMILK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-312-4068
Mailing Address - Street 1:2000 PALMYRA RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1528
Mailing Address - Country:US
Mailing Address - Phone:229-434-2161
Mailing Address - Fax:229-434-2138
Practice Address - Street 1:2000 PALMYRA RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1528
Practice Address - Country:US
Practice Address - Phone:229-434-2161
Practice Address - Fax:229-434-2138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-28
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000001416AMedicaid
110163Medicare PIN