Healthcare Provider Details

I. General information

NPI: 1407963069
Provider Name (Legal Business Name): AMERICUS & SUMTER COUNTY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 06/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WHEATLEY DR
AMERICUS GA
31709-3788
US

IV. Provider business mailing address

100 WHEATLEY DR
AMERICUS GA
31709-3788
US

V. Phone/Fax

Practice location:
  • Phone: 229-931-1265
  • Fax: 229-931-1175
Mailing address:
  • Phone: 229-931-1265
  • Fax: 229-931-1175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number006357
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DARRYL HAWKINS
Title or Position: DIR OF PHCY
Credential: RPH
Phone: 229-931-1265