Healthcare Provider Details

I. General information

NPI: 1740272095
Provider Name (Legal Business Name): DODGE COUNTY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 GRIFFIN AVE
EASTMAN GA
31023-6720
US

IV. Provider business mailing address

901 GRIFFIN AVE
EASTMAN GA
31023-6784
US

V. Phone/Fax

Practice location:
  • Phone: 478-448-4091
  • Fax: 478-448-4088
Mailing address:
  • Phone: 478-448-4435
  • Fax: 478-374-0337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: JAN HAMRICK
Title or Position: CFO
Credential:
Phone: 478-448-4050