Healthcare Provider Details

I. General information

NPI: 1154352458
Provider Name (Legal Business Name): HOSPITAL AUTHORITY OF MITCHELL COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 04/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 PERRY ST
CAMILLA GA
31730-1852
US

IV. Provider business mailing address

920 CAIRO RD
THOMASVILLE GA
31792-4255
US

V. Phone/Fax

Practice location:
  • Phone: 229-336-1499
  • Fax: 229-336-1534
Mailing address:
  • Phone: 229-227-5500
  • Fax: 229-227-5505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number101-120
License Number StateGA

VIII. Authorized Official

Name: GREG HEMBREE
Title or Position: SENIOR VP/CFO
Credential:
Phone: 229-228-2853