Provider Demographics
NPI:1285637728
Name:SMITH RURAL HEALTH CLINIC
Entity Type:Organization
Organization Name:SMITH RURAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-237-7517
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:SWAINSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30401-0160
Mailing Address - Country:US
Mailing Address - Phone:478-237-7517
Mailing Address - Fax:478-237-4299
Practice Address - Street 1:114 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401-3146
Practice Address - Country:US
Practice Address - Phone:478-237-7517
Practice Address - Fax:478-237-4299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-29
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA113829261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00469664GMedicaid
1225102908OtherHOWARD MD NPI
GA10047395OtherAMERIGROUP GA
1225102908OtherBCBSGA/A HOWARD
26760OtherSRHC UNITED HLTHCARE
924053OtherA HOWARD UNITED HLTHCARE
GA034616OtherGA LISCENSE/AHOWARD
1023012580OtherH WILDER SMITH JR PAC NPI
GA10054020OtherAGROUP/A HOWARD
GA336040OtherWELLCARE GEORGIA
GA000241689AMedicaid
1588662506OtherMASON W SMITH PAC NPI
11BDVCZOtherMCAREPARTB/AHOWARD
GA336040OtherWELLCARE GEORGIA
GA113829Medicare ID - Type UnspecifiedRHC MCR #
1588662506OtherMASON W SMITH PAC NPI