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General NPI Number Information
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NPI Number | 1619284445
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Entity Type | Organization
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Legal Business Name | SOUTHERN HEALTH CORP OF ELLIJAY
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Dates
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Enumeration Date | 08/31/2010
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 772 MADDOX DR SUITE 112
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City | EAST ELLIJAY
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State | GA
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Zip | 30540-8194
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Country | US
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Telephone | 706-276-4399
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Fax | 706-276-4741
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Provider Business Mailing Address
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Address Line | PO BOX 1019
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City | ELLIJAY
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State | GA
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Zip | 30540-0013
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Country | US
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Telephone | 706-276-4399
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Fax | 706-276-4741
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Authorized Official
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Title or Position | CFO
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Name | MS. DEBRA ANN SELF
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Credential |
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Telephone | 706-276-4741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 053942
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License Number State | GA
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