Healthcare Provider Details

I. General information

NPI: 1013933944
Provider Name (Legal Business Name): BURKE COUNTY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W 4TH ST
WAYNESBORO GA
30830
US

IV. Provider business mailing address

351 S LIBERTY ST
WAYNESBORO GA
30830-9686
US

V. Phone/Fax

Practice location:
  • Phone: 706-554-2176
  • Fax: 706-554-6407
Mailing address:
  • Phone: 706-437-2655
  • Fax: 706-544-4854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7856
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number7856
License Number StateGA

VIII. Authorized Official

Name: THOMAS K STEINER
Title or Position: CEO/CFO
Credential:
Phone: 706-554-4435