Provider Demographics
NPI:1740516129
Name:HOSPITAL AUTHORITY OF LIBERTY COUNTY
Entity type:Organization
Organization Name:HOSPITAL AUTHORITY OF LIBERTY COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAMERA
Authorized Official - Middle Name:P
Authorized Official - Last Name:MIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-369-9400
Mailing Address - Street 1:455 S MAIN ST STE 105
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-4354
Mailing Address - Country:US
Mailing Address - Phone:912-876-5505
Mailing Address - Fax:912-876-5508
Practice Address - Street 1:455 S MAIN ST STE 105
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-4354
Practice Address - Country:US
Practice Address - Phone:912-876-5505
Practice Address - Fax:912-876-5508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty