Provider Demographics
NPI:1578789665
Name:HOSPITAL AUTHORITY OF WASHINGTON COUNTY
Entity Type:Organization
Organization Name:HOSPITAL AUTHORITY OF WASHINGTON COUNTY
Other - Org Name:WASHINGTON COUNTY SURGICIAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-240-2101
Mailing Address - Street 1:601 SPARTA RD.
Mailing Address - Street 2:P.O. BOX 636
Mailing Address - City:SANDERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31082-1315
Mailing Address - Country:US
Mailing Address - Phone:478-240-2060
Mailing Address - Fax:478-240-2020
Practice Address - Street 1:501 SPARTA RD
Practice Address - Street 2:SUITE - D
Practice Address - City:SANDERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31082-1371
Practice Address - Country:US
Practice Address - Phone:478-552-6790
Practice Address - Fax:478-552-6686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022910174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherTAX ID