Healthcare Provider Details

I. General information

NPI: 1790088169
Provider Name (Legal Business Name): HOSPITAL AUTHORITY OF CANDLER COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2010
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 DOCTORS ST
METTER GA
30439
US

IV. Provider business mailing address

PO BOX 597
METTER GA
30439-0597
US

V. Phone/Fax

Practice location:
  • Phone: 912-685-5715
  • Fax: 912-685-5077
Mailing address:
  • Phone: 912-685-5741
  • Fax: 912-685-6403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLUCK WILLIAM BENNETT III
Title or Position: CHEIF FINANCIAL OFICER
Credential: CFO
Phone: 912-685-1769