Provider Demographics
NPI:1205035771
Name:HOSPITAL AUTHORITY OF WAYNE COUNTY, GEORGIA
Entity Type:Organization
Organization Name:HOSPITAL AUTHORITY OF WAYNE COUNTY, GEORGIA
Other - Org Name:WAYNE MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:IERARDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-530-3302
Mailing Address - Street 1:865 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545-0210
Mailing Address - Country:US
Mailing Address - Phone:912-427-6811
Mailing Address - Fax:912-530-3140
Practice Address - Street 1:865 S 1ST ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-0210
Practice Address - Country:US
Practice Address - Phone:912-427-6811
Practice Address - Fax:912-530-3140
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPITAL AUTHORITY OF WAYNE COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-16
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00002054AMedicaid
GA00002054AMedicaid