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Contact Information

SOUTHERN HEALTH CORP OF ELLIJAY
1362 S MAIN ST
ELLIJAY, GA30540-5410
 Phone: 706-276-4741
 Fax: 706-276-4745
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Skilled Nursing Facility

314000000X A1[8] Skilled Nursing Facility
 

Nursing Facility/Intermediate Care Facility

313M00000X A3[10] Other Nursing Facility
Indicates primary specialty

NPI Profile & details for SOUTHERN HEALTH CORP OF ELLIJAY

NPI Number 1902963580
LBN Legal business name SOUTHERN HEALTH CORP OF ELLIJAY
Authorized official JEFFREY DUNN - (CHIEF EXECUTIVE OFFICER)
Entity Organization
Organization subpart 1 No
Enumeration date 01/02/2007
Last updated 01/17/2008 - About 18 years ago
Identifiers
GA License # 1-061-1232
GA Medicaid 00141127A
GA Other 501001 BLUE CROSS
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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