Healthcare Provider Details

I. General information

NPI: 1053388256
Provider Name (Legal Business Name): HOSPITAL AUTHORITY OF THE CITY OF BAINBRIDGE AND DECATUR COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E SHOTWELL ST
BAINBRIDGE GA
39819-4256
US

IV. Provider business mailing address

1500 E SHOTWELL ST
BAINBRIDGE GA
39819-4256
US

V. Phone/Fax

Practice location:
  • Phone: 229-246-3500
  • Fax: 229-246-8142
Mailing address:
  • Phone: 229-246-3500
  • Fax: 229-246-8142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number43-112
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1-043-500
License Number StateGA

VIII. Authorized Official

Name: KAREN FAIRCLOTH
Title or Position: CFO
Credential:
Phone: 229-246-8211