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General NPI Number Information
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NPI Number | 1285637728
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Entity Type | Organization
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Legal Business Name | SMITH RURAL HEALTH CLINIC
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Dates
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Enumeration Date | 05/29/2005
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Last Update Date | 07/24/2012
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Provider Practice Location Address
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Address Line | 114 S JEFFERSON ST
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City | SWAINSBORO
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State | GA
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Zip | 30401-3146
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Country | US
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Telephone | 478-237-7517
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Fax | 478-237-4299
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Provider Business Mailing Address
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Address Line | PO BOX 160
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City | SWAINSBORO
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State | GA
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Zip | 30401-0160
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Country | US
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Telephone | 478-237-7517
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Fax | 478-237-4299
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Authorized Official
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Title or Position | CLINIC ADMINISTRATOR
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Name | MRS. DEBORAH S WILLIAMSON
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Credential |
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Telephone | 478-237-7517
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 113829
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License Number State | GA
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