Healthcare Provider Details

I. General information

NPI: 1265425334
Provider Name (Legal Business Name): THE BAXLEY APPLING COUNTY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 WALNUT ST
BAXLEY GA
31513-0119
US

IV. Provider business mailing address

PO BOX 2070
BAXLEY GA
31515-2070
US

V. Phone/Fax

Practice location:
  • Phone: 912-367-9841
  • Fax: 912-366-9173
Mailing address:
  • Phone: 912-367-9841
  • Fax: 912-366-9173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1-001-390
License Number StateGA

VIII. Authorized Official

Name: ELAINE PIKE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 912-367-9841