Healthcare Provider Details

I. General information

NPI: 1346209137
Provider Name (Legal Business Name): ST. MARY'S GOOD SAMARITAN HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 LAKE OCONEE PKWY
GREENSBORO GA
30642-4232
US

IV. Provider business mailing address

5401 LAKE OCONEE PKWY
GREENSBORO GA
30642-4232
US

V. Phone/Fax

Practice location:
  • Phone: 706-453-7331
  • Fax: 706-453-2812
Mailing address:
  • Phone: 706-453-7331
  • Fax: 706-453-2812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number066-638
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number066623
License Number StateGA

VIII. Authorized Official

Name: STONISH PIERCE
Title or Position: PRESIDENT & CEO
Credential:
Phone: 706-389-3930