Provider Demographics
NPI:1063832202
Name:EMANUEL COUNTY HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:EMANUEL COUNTY HOSPITAL AUTHORITY
Other - Org Name:RAY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-289-1376
Mailing Address - Street 1:PO BOX 879
Mailing Address - Street 2:
Mailing Address - City:SWAINSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30401-0879
Mailing Address - Country:US
Mailing Address - Phone:478-289-1303
Mailing Address - Fax:478-289-7466
Practice Address - Street 1:401 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401-3110
Practice Address - Country:US
Practice Address - Phone:478-237-9928
Practice Address - Fax:478-237-4517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-25
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207Q00000X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty