Provider Demographics
NPI:1780023911
Name:HOSPITAL AUTHORITY OF VALDOSTA AND LOWNDES COUNTY, GEORGIA
Entity Type:Organization
Organization Name:HOSPITAL AUTHORITY OF VALDOSTA AND LOWNDES COUNTY, GEORGIA
Other - Org Name:SMITH NORTHVIEW HOSPITAL, A CAMPUS OF SOUTH GEORGIA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:SAULS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-333-1020
Mailing Address - Street 1:PO BOX 0070
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31603-0070
Mailing Address - Country:US
Mailing Address - Phone:229-433-8000
Mailing Address - Fax:
Practice Address - Street 1:4280 N VALDOSTA RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-6814
Practice Address - Country:US
Practice Address - Phone:229-433-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPITAL AUTHORITY OF VALDOSTA AND LOWNDES COUNTY, GEORGIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-20
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA092-141282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000001724GMedicaid
GA000001724GMedicaid