Healthcare Provider Details

I. General information

NPI: 1336139401
Provider Name (Legal Business Name): CLARKE COUNTY HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33700 HIGHWAY 43
THOMASVILLE AL
36784-3335
US

IV. Provider business mailing address

33700 HIGHWAY 43
THOMASVILLE AL
36784-3335
US

V. Phone/Fax

Practice location:
  • Phone: 334-636-4431
  • Fax: 334-636-6129
Mailing address:
  • Phone: 334-636-4431
  • Fax: 334-636-6129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateAL

VIII. Authorized Official

Name: MS. LORA TILLMAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 334-636-4431