Provider Demographics
NPI:1194744326
Name:SOUTHEAST GEORGIA HEALTH SYSTEM, INC.
Entity type:Organization
Organization Name:SOUTHEAST GEORGIA HEALTH SYSTEM, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MA
Authorized Official - Phone:912-466-7049
Mailing Address - Street 1:2000 DAN PROCTOR DR
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-3810
Mailing Address - Country:US
Mailing Address - Phone:912-576-6200
Mailing Address - Fax:912-576-6404
Practice Address - Street 1:2000 DAN PROCTOR DR
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-3810
Practice Address - Country:US
Practice Address - Phone:912-576-6200
Practice Address - Fax:912-576-6404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020-472282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00000811AMedicaid
GA51000164OtherBLUE CROSS BLUE SHIELD
GA51000164OtherBLUE CROSS BLUE SHIELD
=========OtherTRICARE
110146Medicare ID - Type Unspecified
CH0951Medicare ID - Type UnspecifiedRR