Provider Demographics
NPI:1407062862
Name:SOUTHERN HEALTH CORP OF ELLIJAY
Entity Type:Organization
Organization Name:SOUTHERN HEALTH CORP OF ELLIJAY
Other - Org Name:APPLE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SELF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-276-4741
Mailing Address - Street 1:PO BOX 1019
Mailing Address - Street 2:
Mailing Address - City:ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30540-0013
Mailing Address - Country:US
Mailing Address - Phone:706-635-5177
Mailing Address - Fax:706-635-5183
Practice Address - Street 1:822 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-3804
Practice Address - Country:US
Practice Address - Phone:706-635-5177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN HEALTH CORP OF ELLIJAY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-15
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11-8518Medicare PIN