Provider Demographics
NPI:1245235837
Name:MORGAN COUNTY GEORGIA HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:MORGAN COUNTY GEORGIA HOSPITAL AUTHORITY
Other - Org Name:MORGAN MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:W
Authorized Official - Last Name:BONHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-342-1667
Mailing Address - Street 1:PO BOX 860
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:GA
Mailing Address - Zip Code:30650-0860
Mailing Address - Country:US
Mailing Address - Phone:706-342-1667
Mailing Address - Fax:706-342-2345
Practice Address - Street 1:1077 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:GA
Practice Address - Zip Code:30650-2073
Practice Address - Country:US
Practice Address - Phone:706-342-1667
Practice Address - Fax:706-342-2345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA104-519282NC0060X
GA1-104-1540314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00694229AMedicaid
GA00694229AMedicaid
GA11Z304Medicare Oscar/Certification
GA111340Medicare Oscar/Certification