Healthcare Provider Details

I. General information

NPI: 1619528031
Provider Name (Legal Business Name): TRI-COUNTY RURAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639A VESTAL RD
SARDIS GA
30456-2155
US

IV. Provider business mailing address

407 LEONARD CIR
WAYNESBORO GA
30830-1354
US

V. Phone/Fax

Practice location:
  • Phone: 478-569-4443
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. CAROLNATHA E CARTER
Title or Position: NURSE PRACTITIONER/PROVIDER
Credential: FNP-BC
Phone: 478-569-4443