MEDICARE: HOSPITAL AUTHORITY OF MITCHELL COUNTY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center	101120	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11D1056726	OTHER	GA	CLIA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922211515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPITAL AUTHORITY OF MITCHELL COUNTY

Provider Business Mailing Address
First Line	:	920 CAIRO ROAD
Second Line	:
City	:	THOMASVILLE
State	:	GA
Zip	:	31792
Country	:	US
Telephone Number	:	229-227-5500
Fax Number	:	229-227-5505

Provider Business Practice Location Address
First Line	:	259 US HIGHWAY 19 NORTH
Second Line	:
City	:	CAMILLA
State	:	GA
Zip	:	31730-1410
Country	:	US
Telephone Number	:	229-336-1949
Fax Number	:	229-336-1436

Authorized Official
Title or Position	:	SENIOR VP/CFO
Name	:	GREG HEMBREE
Credential	:
Telephone Number	:	229-228-2853

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	04/25/2019

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Directions to “HOSPITAL AUTHORITY OF MITCHELL COUNTY ” Practice Location

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