Healthcare Provider Details

I. General information

NPI: 1699769166
Provider Name (Legal Business Name): HOSPITAL AUTHORITY OF RANDOLPH COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 08/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 RANDOLPH ST
CUTHBERT GA
39840-6127
US

IV. Provider business mailing address

361 RANDOLPH ST
CUTHBERT GA
39840-6127
US

V. Phone/Fax

Practice location:
  • Phone: 229-312-6711
  • Fax: 229-732-6759
Mailing address:
  • Phone: 229-312-6711
  • Fax: 229-732-6759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number048502
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number040908
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number042910
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number053465
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number048852
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberPHH003499
License Number StateGA
# 7
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 9
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 10
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: STEVEN WHATLEY
Title or Position: HARC BOARD CHAIRMAN
Credential:
Phone: 229-209-1242