Provider Demographics
NPI:1518354778
Name:ST. MARY'S SACRED HEART HOSPITAL, INC.
Entity Type:Organization
Organization Name:ST. MARY'S SACRED HEART HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-389-3938
Mailing Address - Street 1:367 CLEAR CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:LAVONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30553-4173
Mailing Address - Country:US
Mailing Address - Phone:706-356-7800
Mailing Address - Fax:706-356-7828
Practice Address - Street 1:367 CLEAR CREEK PKWY
Practice Address - Street 2:
Practice Address - City:LAVONIA
Practice Address - State:GA
Practice Address - Zip Code:30553-4173
Practice Address - Country:US
Practice Address - Phone:706-356-7800
Practice Address - Fax:706-356-7828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-24
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000000437AMedicaid