Healthcare Provider Details

I. General information

NPI: 1063832202
Provider Name (Legal Business Name): EMANUEL COUNTY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2014
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W MAIN ST
SWAINSBORO GA
30401-3110
US

IV. Provider business mailing address

PO BOX 879
SWAINSBORO GA
30401-0879
US

V. Phone/Fax

Practice location:
  • Phone: 478-237-9928
  • Fax: 478-237-4517
Mailing address:
  • Phone: 478-289-1303
  • Fax: 478-289-7466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateGA

VIII. Authorized Official

Name: MR. STEVE KING
Title or Position: CFO
Credential:
Phone: 478-289-1376