Healthcare Provider Details

I. General information

NPI: 1588654388
Provider Name (Legal Business Name): EMANUEL COUNTY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 THIRD ST
SOPERTON GA
30457
US

IV. Provider business mailing address

117 KITE RD
SWAINSBORO GA
30401-3231
US

V. Phone/Fax

Practice location:
  • Phone: 912-529-4774
  • Fax: 912-529-4409
Mailing address:
  • Phone: 478-289-1100
  • Fax: 478-289-1300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: H D CANNINGTON
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 478-289-1100