Provider Demographics
NPI:1013961507
Name:GRADY GENERAL HOSPITAL
Entity Type:Organization
Organization Name:GRADY GENERAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:HEMBREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-228-2880
Mailing Address - Street 1:920 CAIRO RD
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-4255
Mailing Address - Country:US
Mailing Address - Phone:229-228-8800
Mailing Address - Fax:229-228-8892
Practice Address - Street 1:1155 5TH ST SE
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:GA
Practice Address - Zip Code:39828-3142
Practice Address - Country:US
Practice Address - Phone:229-377-1150
Practice Address - Fax:229-377-7953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA065-413282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA110121A000000OtherTRAILBLAZER
GA000020OtherBC/BS GA
GA000000844AMedicaid
GA000000844AMedicaid
SCF820Medicare PIN
GAHOSP59Medicare PIN
FLIT921AMedicare Oscar/Certification
GACG7045Medicare PIN
TN103G703717Medicare Oscar/Certification
GA110121A000000OtherTRAILBLAZER