Healthcare Provider Details

I. General information

NPI: 1396045431
Provider Name (Legal Business Name): THE HOSPITAL AUTHORITY OF MILLER COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2010
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 N CUTHBERT ST
COLQUITT GA
39837-3518
US

IV. Provider business mailing address

PO BOX 7 209 N CUTHBERT STREET
COLQUITT GA
39837-0007
US

V. Phone/Fax

Practice location:
  • Phone: 229-758-4245
  • Fax: 229-758-9715
Mailing address:
  • Phone: 229-758-4245
  • Fax: 229-752-9715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License NumberPHRE008934
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROBIN RAU
Title or Position: ADMINISTRATOR
Credential: BACH PHARMACY
Phone: 229-758-4949