NPIMap

Organization Active NPI

Dodge County Hospital Authority

  • Psychiatric Hospital Unit
  • Eastman, GA
National Provider Identifier
1881010239
Registry record updated Jun 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
Legal business name
DODGE COUNTY HOSPITAL AUTHORITY
Practice address
901 Griffin Ave
Eastman, GA 31023-6720
Phone
(478) 448-4000
Fax
(478) 448-4088
NPI assigned
Mar 10, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2023

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
Psychiatric Hospital Unit 273R00000X Primary

Addresses

Primary practice location

901 Griffin Ave
Eastman, GA 31023-6720

Mailing address

901 Griffin Ave
Eastman, GA 31023-6784
Phone (478) 448-4000

Other names 1

  • Dodge County Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140528001500 GA Part A Provider - Hospital 1759372733 Practice locations: Eastman, GA

Hospital certification: CCN 11S092

Legal name
DODGE COUNTY HOSPITAL AUTHORITY
Doing business as
DODGE COUNTY HOSPITAL
Organization structure
OtherNon-profit
Enrollment address
901 Griffin Ave
Eastman, GA 31023-6720
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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.

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Mimi Dennis Individual Corporate Director May 1, 2014
Dodge County Hospital Authority Organization, Eastman, GA Non-profit Other Apr 1, 2014
Mandel T Mullis Individual Corporate Director Mar 31, 2009
Mitchell L Coffee Individual Corporate Director Apr 30, 2008
Ladon Toole Individual Corporate OfficerCeo Mar 1, 2019 100%
Jan Hamrick Individual Corporate Officer May 16, 2012
W-2 Managing Employee May 16, 2012
Cecil B Barden Individual Corporate Director Apr 30, 2004
Arthur Reggie Sheffield Individual Corporate Director Apr 30, 2004
Donald a Selph Individual Corporate DirectorDirector Oct 21, 2020
Byrd D Harrell Individual Corporate Director Aug 1, 2015
John Paul Jones Individual Corporate Director Apr 30, 2006
James T Rahn Individual Corporate Director Mar 28, 2023

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

NPI Registry JSON

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

{
    "created_epoch": "1394409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686614400000",
    "number": "1881010239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 GRIFFIN AVE",
            "city": "EASTMAN",
            "state": "GA",
            "postal_code": "310236784",
            "telephone_number": "478-448-4000",
            "fax_number": "478-448-4088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 GRIFFIN AVE",
            "city": "EASTMAN",
            "state": "GA",
            "postal_code": "310236720",
            "telephone_number": "478-448-4000",
            "fax_number": "478-448-4088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DODGE COUNTY HOSPITAL AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-10",
        "last_updated": "2023-06-13",
        "certification_date": "2023-06-13",
        "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": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dodge County Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dodge County Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eastman, GA

Sources for this page

Verify at the official NPI Registry.