Healthcare Provider Details

I. General information

NPI: 1699779405
Provider Name (Legal Business Name): HOSPITAL AUTHORITY OF WAYNE COUNTY GEORGIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 COLONIAL WAY
JESUP GA
31545-0127
US

IV. Provider business mailing address

PO BOX 565
JESUP GA
31598-0565
US

V. Phone/Fax

Practice location:
  • Phone: 912-427-8051
  • Fax: 912-427-4045
Mailing address:
  • Phone: 912-427-8051
  • Fax: 912-427-4045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number151-031
License Number StateGA

VIII. Authorized Official

Name: MRS. LINDA DENISE HOCKENSMITH
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 912-427-8051