Provider Demographics
NPI:1245201094
Name:SCREVEN COUNTY HOSPITAL
Entity type:Organization
Organization Name:SCREVEN COUNTY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:ST GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-564-7426
Mailing Address - Street 1:215 MIMS RD
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:GA
Mailing Address - Zip Code:30467-1994
Mailing Address - Country:US
Mailing Address - Phone:912-564-7426
Mailing Address - Fax:912-564-0010
Practice Address - Street 1:215 MIMS RD
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:GA
Practice Address - Zip Code:30467-1994
Practice Address - Country:US
Practice Address - Phone:912-564-7426
Practice Address - Fax:912-564-0010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA124-164282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000001647AMedicaid
GA000001647SMedicaid
GA11Z312Medicare Oscar/Certification
GA000001647SMedicaid