Healthcare Provider Details

I. General information

NPI: 1720169147
Provider Name (Legal Business Name): SOUTHEAST GEORGIA HEALTH SYSTEM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 11/07/2022
Certification Date: 02/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 DILWORTH ST
SAINT MARYS GA
31558-8673
US

IV. Provider business mailing address

2415 PARKWOOD DR
BRUNSWICK GA
31520-4722
US

V. Phone/Fax

Practice location:
  • Phone: 912-882-4281
  • Fax: 912-882-9502
Mailing address:
  • Phone: 912-466-7000
  • Fax: 912-466-7026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT RAYNES
Title or Position: PRESIDENT & CEO
Credential: MBA, MA
Phone: 912-466-7049