NPIMap

Organization Active NPI

Dodge County Hospital Authority

  • Family Medicine Physician
  • Eastman, GA
National Provider Identifier
1477211779
Registry record updated Jun 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
DODGE COUNTY HOSPITAL AUTHORITY
Practice address
829 Plaza Ave
Eastman, GA 31023-6757
Phone
(478) 374-7801
Fax
(478) 374-7878
NPI assigned
Dec 3, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 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 PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

829 Plaza Ave
Eastman, GA 31023-6757

Mailing address

829 Plaza Ave
Eastman, GA 31023-6757
Phone (478) 448-8272

Other names 1

  • Dodge Immediate Health, LLC 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
11D2250831Dodge County Hospital Authority829 Plaza Avenue, Eastman, GA 31023Certificate of waiverJan 29, 2028

National Provider Directory

National Provider Directory
Tax ID family
Dodge County Hospital C6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 4

Organizations listed as members of this organization in the National Provider Directory.

Locations

829 Plaza Ave
Eastman, GA 31023
Phone (478) 374-1409

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1638489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749600000000",
    "number": "1477211779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "829 PLAZA AVE",
            "city": "EASTMAN",
            "state": "GA",
            "postal_code": "310236757",
            "telephone_number": "478-448-8272",
            "fax_number": "478-448-8273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "829 PLAZA AVE",
            "city": "EASTMAN",
            "state": "GA",
            "postal_code": "310236757",
            "telephone_number": "478-374-7801",
            "fax_number": "478-374-7878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DODGE COUNTY HOSPITAL AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-03",
        "last_updated": "2025-06-11",
        "certification_date": "2025-06-11",
        "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": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dodge Immediate Health, LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dodge Immediate Health, LLC",
            "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 11, 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.