Healthcare Provider Details

I. General information

NPI: 1063491017
Provider Name (Legal Business Name): HOSPITAL AUTHORITY OF RANDOLPH COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 01/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 RANDOLPH ST
CUTHBERT GA
39840-1338
US

IV. Provider business mailing address

361 RANDOLPH ST
CUTHBERT GA
39840-6127
US

V. Phone/Fax

Practice location:
  • Phone: 229-732-2181
  • Fax: 229-732-6759
Mailing address:
  • Phone: 229-732-2181
  • Fax: 229-732-6759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: CHRISTY LUMPKIN
Title or Position: INFORMATION SYSTEMS
Credential:
Phone: 229-732-2181