NPIMap

Organization Active NPI

Dodge County Hospital Authority

Doing business as Eastman Family Practice

  • Family Medicine Physician
  • Eastman, GA
National Provider Identifier
1255948717
Registry record updated Jun 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
DODGE COUNTY HOSPITAL AUTHORITY
Doing business as
Eastman Family Practice
Practice address
840 Professional Center Dr
Eastman, GA 31023-6734
Phone
(478) 374-7801
Fax
(478) 374-7878
NPI assigned
Sep 29, 2020
Last updated
Jun 3, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
DODGE COUNTY HOSPITAL AUTHORITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 3, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jan Hamrick
Title
Cfo
Phone
(478) 448-4050

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

840 Professional Center Dr
Eastman, GA 31023-6734

Mailing address

840 Professional Center Dr
Eastman, GA 31023-6734
Phone (478) 374-7801

Other names 1

  • Eastman Family Practice Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040519000764 GA Part B Supplier - Clinic/Group Practice 1759372733 Receives reassigned benefits from 20 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Eastman, GA

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2030008Dodge Co Hosp Auth Dba Eastman Family Practice LLC840 Professional Center Drive, Eastman, GA 31023Certificate of waiverMar 20, 2028

National Provider Directory

National Provider Directory
Part of
Louise a Goodman MD

Locations

1112 Plaza Ave
Ste B
Eastman, GA 31023
Phone (478) 374-7801

1207 Plaza Ave
Eastman, GA 31023
Phone (478) 374-2003

840 Professional Center Dr
Eastman, GA 31023
Phone (478) 374-1308

901 Griffin Ave
Ste B
Eastman, GA 31023
Phone (478) 448-4435

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1601337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748908800000",
    "number": "1255948717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 PROFESSIONAL CENTER DR",
            "city": "EASTMAN",
            "state": "GA",
            "postal_code": "310236734",
            "telephone_number": "478-374-7801",
            "fax_number": "478-374-7878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 PROFESSIONAL CENTER DR",
            "city": "EASTMAN",
            "state": "GA",
            "postal_code": "310236734",
            "telephone_number": "478-374-7801",
            "fax_number": "478-374-7878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DODGE COUNTY HOSPITAL AUTHORITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DODGE COUNTY HOSPITAL AUTHORITY",
        "enumeration_date": "2020-09-29",
        "last_updated": "2025-06-03",
        "certification_date": "2025-06-03",
        "status": "A",
        "authorized_official_last_name": "HAMRICK",
        "authorized_official_first_name": "JAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "478-448-4050"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eastman Family Practice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Eastman Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eastman, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.