Provider Demographics
NPI:1194141549
Name:HOSPITAL AUTHORITY OF VALDOSTA AND LOWNDES COUNTY GEORGIA
Entity type:Organization
Organization Name:HOSPITAL AUTHORITY OF VALDOSTA AND LOWNDES COUNTY GEORGIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:W
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-259-4140
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31603-0009
Mailing Address - Country:US
Mailing Address - Phone:229-482-8421
Mailing Address - Fax:229-482-8543
Practice Address - Street 1:138 W THIGPEN AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:GA
Practice Address - Zip Code:31635-1011
Practice Address - Country:US
Practice Address - Phone:229-482-8421
Practice Address - Fax:229-482-8543
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPITAL AUTHORITY OF VALDOSTA AND LOWNDES COUNTY GEORGIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-10
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-086-2043313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000141732AMedicaid
GA115707Medicare Oscar/Certification