Healthcare Provider Details

I. General information

NPI: 1306896253
Provider Name (Legal Business Name): HOSPITAL AUTHORITY OF VALDOSTA AND LOWNDES COUNTY GEORGIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N PATTERSON ST
VALDOSTA GA
31602-1735
US

IV. Provider business mailing address

PO BOX 9
VALDOSTA GA
31603-0009
US

V. Phone/Fax

Practice location:
  • Phone: 229-433-1000
  • Fax:
Mailing address:
  • Phone: 229-433-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number92141
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number92141
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number09201
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number92141
License Number StateGA
# 5
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number92141
License Number StateGA

VIII. Authorized Official

Name: MRS. JULIE HODGES
Title or Position: CONTROLLER
Credential:
Phone: 229-259-4140