Healthcare Provider Details

I. General information

NPI: 1316027352
Provider Name (Legal Business Name): HOSPITAL AUTHORITY OF CALHOUN COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 R E JENNINGS AVE
ARLINGTON GA
39813
US

IV. Provider business mailing address

55 R E JENNINGS AVE
ARLINGTON GA
39813
US

V. Phone/Fax

Practice location:
  • Phone: 229-725-4272
  • Fax:
Mailing address:
  • Phone: 229-725-4272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number StateGA

VIII. Authorized Official

Name: MRS. DENISE W STEWART
Title or Position: BOM
Credential:
Phone: 229-725-2147