Provider Demographics
NPI:1528298668
Name:LONG COUNTY HEALTH CENTER
Entity type:Organization
Organization Name:LONG COUNTY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:IERARDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-530-3302
Mailing Address - Street 1:865 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545-0210
Mailing Address - Country:US
Mailing Address - Phone:912-427-6811
Mailing Address - Fax:912-530-3495
Practice Address - Street 1:40 E CYPRESS ST
Practice Address - Street 2:BLDG A
Practice Address - City:LUDOWICI
Practice Address - State:GA
Practice Address - Zip Code:31316
Practice Address - Country:US
Practice Address - Phone:912-302-4067
Practice Address - Fax:912-302-4068
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPITAL AUTHORITY OF WAYNE COUNTY GEORGIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-23
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherEIN