Provider Demographics
NPI:1386664779
Name:WELLSTAR SYLVAN GROVE HOSPITAL, INC
Entity Type:Organization
Organization Name:WELLSTAR SYLVAN GROVE HOSPITAL, INC
Other - Org Name:SYLVAN GROVE HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUZDINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-644-0012
Mailing Address - Street 1:1800 PARKWAY PL SE STE 500
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8237
Mailing Address - Country:US
Mailing Address - Phone:470-956-4981
Mailing Address - Fax:770-999-2489
Practice Address - Street 1:1050 MCDONOUGH RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:GA
Practice Address - Zip Code:30233-1524
Practice Address - Country:US
Practice Address - Phone:770-775-7861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00001856AMedicaid
GA00791062EMedicaid
GA00885024BMedicaid
MO010492809(TRR)Medicaid
GA00282488BMedicaid
GA00495382DMedicaid
416159OtherCOVENTRY HEALTH CARE GEOR
973964590OtherAETNA US HEALTHCARE
GA00214607FMedicaid
GA085001319GMedicaid
004378OtherBCBS OF GEORGIA
152710726OtherKAISER FOUNDATION HEALTH
LA1703761Medicaid
23360OtherCOVENTRY HEALTH CARE GEOR
GA00211549EMedicaid
000444OtherHUMANA
111319B000000OtherSECTION 1011
GA00001856SMedicaid
GA00715107TMedicaid
GA00715107TMedicaid