Southern Community Hospice, Inc.
Organization Active NPI Community Based Hospice Care Agency · Vidalia, GA
NPI 1497832844 · NPPES record last updated Jul 25, 2025
Key facts
- NPI
- 1497832844
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- License
- 138135H (GA)
- Legal business name
- SOUTHERN COMMUNITY HOSPICE, INC.
- Practice address
- 904 Mount Vernon Rd
Vidalia, GA 30474-3030 - Phone
- (912) 537-0063
- Fax
- (912) 537-2005
- NPI assigned
- Nov 1, 2006
- Organization subpart
- No
Authorized official
- Name
- Krista Howard
- Title
- Authorized Billing Official
- Phone
- (478) 374-4888
Owners & managing parties with NPI records 1
Member of 1
Affiliated clinicians 10
-
Mark Hoerman, MD
-
Jason Laney, M.D.
-
Frederick Martinez, M.D.
-
Misty Denise Poole, M.D.
-
James L Ray, MD
-
Ronnie R Smith, M. D.
Medicare Care Compare: Hospice
- Listed as
- Community Hospice
- Ownership
- For-Profit
- Certified
- Oct 28, 1999
- Medicare certification status
- Active
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D1040513 | Southern Community Hospice, Inc | Certificate of waiver | Dec 8, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Hospice certification: CCN 111576
- Legal name
- SOUTHERN COMMUNITY HOSPICE, INC.
- Doing business as
- COMMUNITY HOSPICE
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Oct 28, 1999
- Last certification
- Mar 24, 2021
- Ownership / control type
- Proprietary - Corporation
- Organization structure
- Corporation · Proprietary
- Incorporated
- Jun 23, 1999 in GA
- Enrollment address
- 904 Mount Vernon Rd
Vidalia, GA 30474-3057
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Krista Howard |
Other | Jan 1, 2025 | |
| Michael Dwozan |
5% Or Greater Direct Ownership Interest |
Apr 1, 2023 | 100% |
| 5% Or Greater Indirect Ownership Interest | Apr 1, 2023 | ||
| Marci McCranie |
Corporate Officer |
Dec 1, 2025 | |
| Operational/Managerial Control |
Jan 1, 2025 | ||
| Hospice Care Options Inc |
5% Or Greater Direct Ownership Interest | Mar 31, 2023 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20111215000770 | GA | Part a Provider - Hospice | 9032384250 | Practice locations: Vidalia, GA |
National Provider Directory
Locations
904 Mount Vernon Rd
Ste A
Vidalia, GA 30474
Phone (478) 374-4888
904 Mount Vernon Rd
Vidalia, GA 30474
Phone (912) 537-0063
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | 138135H | GA | Yes |
| Inpatient Hospice | 315D00000X | 138135H | GA |
Addresses
Primary practice location
904 Mount Vernon Rd
Vidalia, GA 30474-3030
Mailing address
715 Legion Dr
Eastman, GA 31023-6780
Phone (478) 374-4888
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000851133A | Medicaid | GA |
Other names
- Community Hospice
Other providers in Vidalia, GA
- Southeast Regional Primary Care Corporation
- Southeastern Cardiology
- Southeastern Cardiovascular Img, Inc.
- Southern Chiro Vidalia, LLC
- Southern Choices LLC
- Southern Magnolia Personal Care Home
- John V Spence
- Charles M Spivey
- John Casey Spivey
- Carl Leland Stalvey
All providers in Vidalia, GA · Community Based Hospice Care Agency in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 25, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.