Healthcare Provider Details

I. General information

NPI: 1073752143
Provider Name (Legal Business Name): THE BAXLEY AND APPLING COUNTY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2009
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E TOLLISON ST STE B
BAXLEY GA
31513-0150
US

IV. Provider business mailing address

PO BOX 2070
BAXLEY GA
31515-2070
US

V. Phone/Fax

Practice location:
  • Phone: 912-367-0102
  • Fax: 912-367-9966
Mailing address:
  • Phone: 912-367-0102
  • Fax: 912-367-9966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number001-502
License Number StateGA

VIII. Authorized Official

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