Provider Demographics
NPI:1568117737
Name:MITCHELL COUNTY PEDIATRICS AND HEALTH CENTER
Entity Type:Organization
Organization Name:MITCHELL COUNTY PEDIATRICS AND HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RCM
Authorized Official - Prefix:
Authorized Official - First Name:ALANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-820-9447
Mailing Address - Street 1:94 E OAKLAND AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CAMILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31730-1529
Mailing Address - Country:US
Mailing Address - Phone:229-449-6671
Mailing Address - Fax:
Practice Address - Street 1:94 E OAKLAND AVE STE A
Practice Address - Street 2:
Practice Address - City:CAMILLA
Practice Address - State:GA
Practice Address - Zip Code:31730-1529
Practice Address - Country:US
Practice Address - Phone:229-449-6671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003218939AMedicaid