Provider Demographics
NPI:1477759462
Name:HOSPITAL AUTHORITY OF WILKES COUNTY
Entity Type:Organization
Organization Name:HOSPITAL AUTHORITY OF WILKES COUNTY
Other - Org Name:WILLS MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURRISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-678-9213
Mailing Address - Street 1:120 GORDON ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30673-1602
Mailing Address - Country:US
Mailing Address - Phone:706-678-9211
Mailing Address - Fax:706-678-1546
Practice Address - Street 1:120 GORDON ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:GA
Practice Address - Zip Code:30673-1602
Practice Address - Country:US
Practice Address - Phone:706-678-9211
Practice Address - Fax:706-678-1546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA157-200282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00002087SMedicaid
GA00002087SMedicaid