Provider Demographics
NPI:1457562209
Name:MORGAN COUNTY GEORGIA HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:MORGAN COUNTY GEORGIA HOSPITAL AUTHORITY
Other - Org Name:MORGAN MEMORIAL HOSPITAL TCU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:HENLEY
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPA, MBA
Authorized Official - Phone:706-752-2284
Mailing Address - Street 1:PO BOX 860
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:GA
Mailing Address - Zip Code:30650-0860
Mailing Address - Country:US
Mailing Address - Phone:706-752-2284
Mailing Address - Fax:706-342-3419
Practice Address - Street 1:1077 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:GA
Practice Address - Zip Code:30650-2073
Practice Address - Country:US
Practice Address - Phone:706-752-2284
Practice Address - Fax:706-342-3419
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MORGAN MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-104-1540314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1457562209Medicare UPIN
GA115653Medicare PIN