MEDICARE: JENKINS COUNTY 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	RHCS001178	GA

General Provider Information

NPI Number	:	1720090665
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENKINS COUNTY AUTHORITY

Provider Business Mailing Address
First Line	:	961 EAST WINTHROPE AVENUE
Second Line	:
City	:	MILLEN
State	:	GA
Zip	:	30442-1839
Country	:	US
Telephone Number	:	478-982-9081
Fax Number	:	478-982-8843

Provider Business Practice Location Address
First Line	:	961 EAST WINTHROPE AVENUE
Second Line	:
City	:	MILLEN
State	:	GA
Zip	:	30442-1839
Country	:	US
Telephone Number	:	478-982-9081
Fax Number	:	478-982-8843

Authorized Official
Title or Position	:	HOSPITAL ADMINISTRATOR
Name	:	MR. ALVIN BURKE
Credential	:
Telephone Number	:	478-982-9081

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	08/22/2020

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Directions to “JENKINS COUNTY AUTHORITY ” Practice Location

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