Provider Demographics
NPI:1619284445
Name:SOUTHERN HEALTH CORP OF ELLIJAY
Entity Type:Organization
Organization Name:SOUTHERN HEALTH CORP OF ELLIJAY
Other - Org Name:NORTH GEORGIA ORTHOPEDIC SURGERY AND SPORTS MEDICINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SELF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-276-4741
Mailing Address - Street 1:PO BOX 1019
Mailing Address - Street 2:
Mailing Address - City:ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30540-0013
Mailing Address - Country:US
Mailing Address - Phone:706-276-4399
Mailing Address - Fax:706-276-4741
Practice Address - Street 1:772 MADDOX DR
Practice Address - Street 2:SUITE 112
Practice Address - City:EAST ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-8194
Practice Address - Country:US
Practice Address - Phone:706-276-4399
Practice Address - Fax:706-276-4741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053942282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1821059510OtherBRIAN ROWAN'S NPI NUMBER
GAHOSP34OtherSOUTHERN HEALTH CORP OF ELLIJAYDBA NORTH GEORGIA MEDICAL CENTER PROVIDER NUMBER
GAHOSP34OtherSOUTHERN HEALTH CORP OF ELLIJAYDBA NORTH GEORGIA MEDICAL CENTER PROVIDER NUMBER
BR7476179OtherDEA