Healthcare Provider Details

I. General information

NPI: 1194629113
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: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 WHEAT AVE STE 700
BAINBRIDGE GA
39819-4369
US

IV. Provider business mailing address

603 WHEAT AVE STE 700
BAINBRIDGE GA
39819-4369
US

V. Phone/Fax

Practice location:
  • Phone: 229-243-6100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: KAREN FAIRCLOTH
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 229-243-6100