Provider Demographics
NPI:1326571019
Name:HOSPICE OF SOUTH GEORGIA
Entity Type:Organization
Organization Name:HOSPICE OF SOUTH GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:912-588-0080
Mailing Address - Street 1:1625 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545-7969
Mailing Address - Country:US
Mailing Address - Phone:912-588-0080
Mailing Address - Fax:912-588-0082
Practice Address - Street 1:1625 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-7969
Practice Address - Country:US
Practice Address - Phone:912-588-0080
Practice Address - Fax:912-588-0082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-10
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000840243AMedicaid
GA000840243AMedicaid