Provider Demographics
NPI:1255948717
Name:DODGE COUNTY HOSPITAL AUTHORITY
Entity type:Organization
Organization Name:DODGE COUNTY HOSPITAL AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-448-4050
Mailing Address - Street 1:840 PROFESSIONAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-6734
Mailing Address - Country:US
Mailing Address - Phone:478-374-7801
Mailing Address - Fax:478-374-7878
Practice Address - Street 1:840 PROFESSIONAL CENTER DR
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-6734
Practice Address - Country:US
Practice Address - Phone:478-374-7801
Practice Address - Fax:478-374-7878
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DODGE COUNTY HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-29
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003257063AMedicaid