Healthcare Provider Details

I. General information

NPI: 1891149100
Provider Name (Legal Business Name): THE BAXLEY AND APPLING COUNTY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 FAIR ST
BAXLEY GA
31513-0112
US

IV. Provider business mailing address

507 FAIR ST
BAXLEY GA
31513-0112
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN116307
License Number StateGA

VIII. Authorized Official

Name: MR. RAYMOND JAMES LEADBETTER JR.
Title or Position: CEO
Credential:
Phone: 912-367-9841