# EAST GEORGIA REGIONAL MEDICAL CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** East Georgia Regional Medical Center LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265486278
- **Authorized official:** PAULA M LALOR (DIRECTOR/DELEGATED OFFICIAL)
- **Authorized official phone:** (629) 215-3953

## Contact information

- **Practice address:** 1499 FAIR RD, STATESBORO, GA 30458-1683
- **Practice address phone:** (912) 486-1000
- **Mailing address:** PO BOX 405998, ATLANTA, GA 30384-5998
- **Mailing address phone:** (912) 486-1000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 282N00000X | General Acute Care Hospital | 016506 | GA | Yes |

## Other

- **Enumeration date:** 05/22/2006
- **Last updated:** 04/01/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00000272A | — | GA |
| 01 | — | 000913 | BLUE CROSS | GA |