Provider Demographics
NPI:1578334264
Name:HOSPITAL AUTHORITY OF JEFF DAVIS COUNTY GEORGIA
Entity Type:Organization
Organization Name:HOSPITAL AUTHORITY OF JEFF DAVIS COUNTY GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-375-7781
Mailing Address - Street 1:PO BOX 1690
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:GA
Mailing Address - Zip Code:31539-1690
Mailing Address - Country:US
Mailing Address - Phone:912-375-7781
Mailing Address - Fax:
Practice Address - Street 1:11 CROSS ST
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:GA
Practice Address - Zip Code:31539-6427
Practice Address - Country:US
Practice Address - Phone:912-699-6570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPITAL AUTHORITY OF JEFF DAVIS COUNTY GEORGIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty