Healthcare Provider Details

I. General information

NPI: 1619961695
Provider Name (Legal Business Name): HOSPITAL AUTHORITY OF WILKES COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 GORDON ST
WASHINGTON GA
30673-1602
US

IV. Provider business mailing address

120 GORDON ST
WASHINGTON GA
30673-1602
US

V. Phone/Fax

Practice location:
  • Phone: 706-678-2151
  • Fax: 706-678-1546
Mailing address:
  • Phone: 706-678-2151
  • Fax: 706-678-1546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number157-200
License Number StateGA

VIII. Authorized Official

Name: TRACIE BURRISS
Title or Position: CFO
Credential:
Phone: 706-678-9213