Provider Demographics
NPI:1790888089
Name:HOSPITAL AUTHORITY OF CANDLER COUNTY
Entity Type:Organization
Organization Name:HOSPITAL AUTHORITY OF CANDLER COUNTY
Other - Org Name:CANDLER COUNTY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-685-1769
Mailing Address - Street 1:PO BOX 597
Mailing Address - Street 2:
Mailing Address - City:METTER
Mailing Address - State:GA
Mailing Address - Zip Code:30439-0597
Mailing Address - Country:US
Mailing Address - Phone:912-685-1769
Mailing Address - Fax:912-685-6403
Practice Address - Street 1:400 CEDAR STREET
Practice Address - Street 2:
Practice Address - City:METTER
Practice Address - State:GA
Practice Address - Zip Code:30439-3706
Practice Address - Country:US
Practice Address - Phone:912-685-1769
Practice Address - Fax:912-685-6403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021-023282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00000316AMedicaid
GA111334Medicare ID - Type UnspecifiedPROVIDER NUMBER