Healthcare Provider Details

I. General information

NPI: 1841320280
Provider Name (Legal Business Name): SOUTHWESTERN STATE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 GILLIONVILLE RD STE B
ALBANY GA
31707-3963
US

IV. Provider business mailing address

400 S PINETREE BLVD PATIENT BILLING DEPT
THOMASVILLE GA
31792-7128
US

V. Phone/Fax

Practice location:
  • Phone: 229-227-2955
  • Fax: 229-227-2955
Mailing address:
  • Phone: 229-227-2977
  • Fax: 229-227-2955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number581130678
License Number StateGA

VIII. Authorized Official

Name: MRS. HILARY J HOO-YOU
Title or Position: REGIONAL HOSPITAL ADMINISTRATOR
Credential:
Phone: 229-227-3020