Provider Demographics
NPI:1750331401
Name:SOUTH GEORGIA HEALTH ALLIANCE DBA HOSPICE OF SOUTH GEORGIA
Entity Type:Organization
Organization Name:SOUTH GEORGIA HEALTH ALLIANCE DBA HOSPICE OF SOUTH GEORGIA
Other - Org Name:HOSPICE OF SOUTH GEORGIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-433-7000
Mailing Address - Street 1:2263 PINEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-7316
Mailing Address - Country:US
Mailing Address - Phone:229-433-7000
Mailing Address - Fax:229-433-7003
Practice Address - Street 1:2263 PINEVIEW DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-7316
Practice Address - Country:US
Practice Address - Phone:229-433-7000
Practice Address - Fax:229-433-7025
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH GEORGIA HEALTH ALLIANCE DBA HOSPICE OF SOUTH GEORGIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-12
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA092031H251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000575462AMedicaid