Provider Demographics
NPI:1023593498
Name:HOSPITAL AUTHORITY OF JEFF DAVIS COUNTY GEORGIA
Entity type:Organization
Organization Name:HOSPITAL AUTHORITY OF JEFF DAVIS COUNTY GEORGIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-375-7781
Mailing Address - Street 1:163 S TALLAHASSEE ST
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:GA
Mailing Address - Zip Code:31539-6465
Mailing Address - Country:US
Mailing Address - Phone:912-375-7781
Mailing Address - Fax:912-375-4881
Practice Address - Street 1:163 S TALLAHASSEE ST
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:GA
Practice Address - Zip Code:31539-6465
Practice Address - Country:US
Practice Address - Phone:912-375-7781
Practice Address - Fax:912-375-4881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-01
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health