Provider Demographics
NPI:1891149100
Name:THE BAXLEY AND APPLING COUNTY HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:THE BAXLEY AND APPLING COUNTY HOSPITAL AUTHORITY
Other - Org Name:SOUTHERN PEACHES A DIVISION OF APPLING HEALTHCARE SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LEADBETTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:912-367-9841
Mailing Address - Street 1:507 FAIR ST
Mailing Address - Street 2:
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31513-0112
Mailing Address - Country:US
Mailing Address - Phone:912-367-9841
Mailing Address - Fax:912-367-1272
Practice Address - Street 1:507 FAIR ST
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-0112
Practice Address - Country:US
Practice Address - Phone:912-367-9841
Practice Address - Fax:912-367-1272
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE BAXLEY AND APPLING COUNTY HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-22
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN116307363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty