Provider Demographics
NPI:1518550870
Name:CLINCH COUNTY HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:CLINCH COUNTY HOSPITAL AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:P
Authorized Official - Last Name:AMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-487-4348
Mailing Address - Street 1:1050 VALDOSTA HWY
Mailing Address - Street 2:
Mailing Address - City:HOMERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31634-9701
Mailing Address - Country:US
Mailing Address - Phone:912-487-4350
Mailing Address - Fax:
Practice Address - Street 1:1050 VALDOSTA HWY
Practice Address - Street 2:
Practice Address - City:HOMERVILLE
Practice Address - State:GA
Practice Address - Zip Code:31634-9701
Practice Address - Country:US
Practice Address - Phone:912-487-4350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy