Healthcare Provider Details

I. General information

NPI: 1326756339
Provider Name (Legal Business Name): THE HOSPITAL AUTHORITY OF MILLER COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 11/08/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 TURNER ST
EDISON GA
39846-6039
US

IV. Provider business mailing address

PO BOX 7
COLQUITT GA
39837-0007
US

V. Phone/Fax

Practice location:
  • Phone: 229-835-2251
  • Fax: 229-835-2100
Mailing address:
  • Phone: 229-758-4212
  • Fax: 229-758-2668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CRISSA P SHAW
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 229-758-4212