Provider Demographics
NPI:1205990546
Name:SOUTH HEALTH DISTRICT
Entity type:Organization
Organization Name:SOUTH HEALTH DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DISTRICT ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIDGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-333-5290
Mailing Address - Street 1:PO BOX 5147
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31603-5147
Mailing Address - Country:US
Mailing Address - Phone:229-333-5290
Mailing Address - Fax:229-333-7822
Practice Address - Street 1:503 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HAHIRA
Practice Address - State:GA
Practice Address - Zip Code:31632-1028
Practice Address - Country:US
Practice Address - Phone:229-794-2665
Practice Address - Fax:229-794-3651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003205002AMedicaid