Provider Demographics
NPI:1083938716
Name:EMANUEL COUNTY HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:EMANUEL COUNTY HOSPITAL AUTHORITY
Other - Org Name:EMANUEL PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DURDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-289-1374
Mailing Address - Street 1:131B VICTORY DR
Mailing Address - Street 2:
Mailing Address - City:SWAINSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30401-3234
Mailing Address - Country:US
Mailing Address - Phone:478-289-1374
Mailing Address - Fax:478-289-1300
Practice Address - Street 1:125 VICTORY DR
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401-3234
Practice Address - Country:US
Practice Address - Phone:478-289-1374
Practice Address - Fax:478-289-1300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-24
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center