Healthcare Provider Details

I. General information

NPI: 1518967116
Provider Name (Legal Business Name): THE BAXLEY AND APPLING COUNTY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 E TOLLISON ST
BAXLEY GA
31513-0120
US

IV. Provider business mailing address

PO BOX 2070
BAXLEY GA
31515-2070
US

V. Phone/Fax

Practice location:
  • Phone: 912-367-9841
  • Fax: 912-367-7203
Mailing address:
  • Phone: 912-367-9841
  • Fax: 912-367-1272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number001-502
License Number StateGA

VIII. Authorized Official

Name: ANDREA PIERCE
Title or Position: CEO
Credential:
Phone: 912-367-9841