Healthcare Provider Details

I. General information

NPI: 1497832844
Provider Name (Legal Business Name): SOUTHERN COMMUNITY HOSPICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 MOUNT VERNON RD
VIDALIA GA
30474-3030
US

IV. Provider business mailing address

715 LEGION DR
EASTMAN GA
31023-6780
US

V. Phone/Fax

Practice location:
  • Phone: 912-537-0063
  • Fax: 912-537-2005
Mailing address:
  • Phone: 478-374-4888
  • Fax: 478-374-0504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number138135H
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number138135H
License Number StateGA

VIII. Authorized Official

Name: KRISTA HOWARD
Title or Position: AUTHORIZED BILLING OFFICIAL
Credential:
Phone: 478-374-4888