Provider Demographics
NPI:1013116060
Name:GOOD SAMARITAN HOSPITAL, INC.
Entity Type:Organization
Organization Name:GOOD SAMARITAN HOSPITAL, INC.
Other - Org Name:ST. MARY'S GOOD SAMARITAN HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-389-3938
Mailing Address - Street 1:5401 LAKE OCONEE PKWY
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-4232
Mailing Address - Country:US
Mailing Address - Phone:706-453-7331
Mailing Address - Fax:706-453-2812
Practice Address - Street 1:5401 LAKE OCONEE PKWY
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-4232
Practice Address - Country:US
Practice Address - Phone:706-453-7331
Practice Address - Fax:706-453-2696
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOOD SAMARITAN HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-11
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA066-638275N00000X, 275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000001328SMedicaidSWING
GA000013285Medicaid
GA000001328SMedicaidSWING
GA000013285Medicaid