Provider Demographics
NPI:1467404046
Name:HOSPITAL AUTHORITY OF VALDOSTA AND LOWNDES COUNTY GEORGIA
Entity Type:Organization
Organization Name:HOSPITAL AUTHORITY OF VALDOSTA AND LOWNDES COUNTY GEORGIA
Other - Org Name:SOUTH GEORGIA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-259-4140
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31603-0009
Mailing Address - Country:US
Mailing Address - Phone:229-433-1000
Mailing Address - Fax:
Practice Address - Street 1:2501 N PATTERSON ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1735
Practice Address - Country:US
Practice Address - Phone:229-433-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPITAL AUTHORITY OF VALDOSTA AND LOWNDES COUNTY GEORGIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-16
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA92141261QR0400X, 273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAHOSP24Medicare PIN
GA11T122Medicare Oscar/Certification
GAHOSP24Medicare PIN