Provider Demographics
NPI:1578637047
Name:BROOKS COUNTY HOSPITAL
Entity Type:Organization
Organization Name:BROOKS COUNTY HOSPITAL
Other - Org Name:BROOKS COUNTY HOSPITAL - SWINGBED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:HEMBREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-228-2853
Mailing Address - Street 1:920 CAIRO RD
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-4255
Mailing Address - Country:US
Mailing Address - Phone:229-228-8800
Mailing Address - Fax:229-228-8892
Practice Address - Street 1:903 N COURT ST
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:GA
Practice Address - Zip Code:31643-1315
Practice Address - Country:US
Practice Address - Phone:229-263-4171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROOKS COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-17
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014-428275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000000239SMedicaid
GA000000239SMedicaid