Provider Demographics
NPI:1700830247
Name:HOSPITAL AUTHORITY OF MITCHELL COUNTY
Entity Type:Organization
Organization Name:HOSPITAL AUTHORITY OF MITCHELL COUNTY
Other - Org Name:MITCHELL COUNTY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:HEMBREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-228-2880
Mailing Address - Street 1:920 CAIRO RD
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-4255
Mailing Address - Country:US
Mailing Address - Phone:229-228-8800
Mailing Address - Fax:229-228-8892
Practice Address - Street 1:90 E STEPHENS ST
Practice Address - Street 2:
Practice Address - City:CAMILLA
Practice Address - State:GA
Practice Address - Zip Code:31730-1836
Practice Address - Country:US
Practice Address - Phone:229-336-5284
Practice Address - Fax:229-336-4682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101-120282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111331A000000OtherTRAILBLAZER
GA000001339AMedicaid
GA000020OtherBC/BS GA
FLIU657AMedicare Oscar/Certification
SCF822Medicare PIN
GA111331Medicare Oscar/Certification
GACG6381Medicare PIN
GA111331A000000OtherTRAILBLAZER
TN103G703718Medicare Oscar/Certification
GACJ5034Medicare PIN