Provider Demographics
NPI:1063491017
Name:HOSPITAL AUTHORITY OF RANDOLPH COUNTY
Entity Type:Organization
Organization Name:HOSPITAL AUTHORITY OF RANDOLPH COUNTY
Other - Org Name:SOUTHWEST GEORGIA REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INFORMATION SYSTEMS
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUMPKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-732-2181
Mailing Address - Street 1:361 RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:CUTHBERT
Mailing Address - State:GA
Mailing Address - Zip Code:39840-6127
Mailing Address - Country:US
Mailing Address - Phone:229-732-2181
Mailing Address - Fax:229-732-6759
Practice Address - Street 1:109 RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:CUTHBERT
Practice Address - State:GA
Practice Address - Zip Code:39840-1338
Practice Address - Country:US
Practice Address - Phone:229-732-2181
Practice Address - Fax:229-732-6759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11Z300Medicare Oscar/Certification
GAHOSP3Medicare PIN