Provider Demographics
NPI:1699779405
Name:HOSPITAL AUTHORITY OF WAYNE COUNTY GEORGIA
Entity type:Organization
Organization Name:HOSPITAL AUTHORITY OF WAYNE COUNTY GEORGIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:HOCKENSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:912-427-8051
Mailing Address - Street 1:PO BOX 565
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31598-0565
Mailing Address - Country:US
Mailing Address - Phone:912-427-8051
Mailing Address - Fax:912-427-4045
Practice Address - Street 1:140 COLONIAL WAY
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-0127
Practice Address - Country:US
Practice Address - Phone:912-427-8051
Practice Address - Fax:912-427-4045
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPITAL AUTHORITY OF WAYNE COUNTY GEORGIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-09
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA151-031251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00041335Medicaid
GA00041335Medicaid