Healthcare Provider Details

I. General information

NPI: 1285637728
Provider Name (Legal Business Name): SMITH RURAL HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2005
Last Update Date: 07/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 S JEFFERSON ST
SWAINSBORO GA
30401-3146
US

IV. Provider business mailing address

PO BOX 160
SWAINSBORO GA
30401-0160
US

V. Phone/Fax

Practice location:
  • Phone: 478-237-7517
  • Fax: 478-237-4299
Mailing address:
  • Phone: 478-237-7517
  • Fax: 478-237-4299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number113829
License Number StateGA

VIII. Authorized Official

Name: MRS. DEBORAH S WILLIAMSON
Title or Position: CLINIC ADMINISTRATOR
Credential:
Phone: 478-237-7517