Provider Demographics
NPI:1326079260
Name:HOSPITAL AUTHORITY OF LIBERTY COUNTY
Entity Type:Organization
Organization Name:HOSPITAL AUTHORITY OF LIBERTY COUNTY
Other - Org Name:LIBERTY REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:ROZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-369-9427
Mailing Address - Street 1:PO BOX 919
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31310-0919
Mailing Address - Country:US
Mailing Address - Phone:912-369-9400
Mailing Address - Fax:912-877-9438
Practice Address - Street 1:462 E G MILES PARKWAY
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-4000
Practice Address - Country:US
Practice Address - Phone:912-369-9400
Practice Address - Fax:912-877-9438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000001152AMedicaid
GA000856028AMedicaid
GA000856028AMedicaid
GA111335Medicare ID - Type Unspecified
GA000001152AMedicaid