Healthcare Provider Details

I. General information

NPI: 1124038294
Provider Name (Legal Business Name): HOSPITAL AUTHORITY OF BEN HILL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PERRY HOUSE RD
FITZGERALD GA
31750-8857
US

IV. Provider business mailing address

200 PERRY HOUSE RD PO BOX 1447
FITZGERALD GA
31750-8857
US

V. Phone/Fax

Practice location:
  • Phone: 229-424-7100
  • Fax: 229-424-7281
Mailing address:
  • Phone: 229-424-7100
  • Fax: 229-424-7281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number009-288
License Number StateGA

VIII. Authorized Official

Name: MRS. PAIGE PAULK WYNN
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CPA
Phone: 229-424-7100