MEDICARE: EMANUEL COUNTY HOSPITAL AUTHORITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134119936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMANUEL COUNTY HOSPITAL AUTHORITY

Provider Business Mailing Address
First Line	:	117 KITE RD
Second Line	:
City	:	SWAINSBORO
State	:	GA
Zip	:	30401-3231
Country	:	US
Telephone Number	:	478-289-1100
Fax Number	:	478-289-1300

Provider Business Practice Location Address
First Line	:	511 GILLIKEN ST
Second Line	:
City	:	TWIN CITY
State	:	GA
Zip	:	30471
Country	:	US
Telephone Number	:	478-763-3036
Fax Number	:	478-763-3787

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. H D CANNINGTON
Credential	:
Telephone Number	:	478-289-1100

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	08/22/2020

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