Provider Demographics
NPI:1720090665
Name:JENKINS COUNTY AUTHORITY
Entity Type:Organization
Organization Name:JENKINS COUNTY AUTHORITY
Other - Org Name:JENKINS COUNTY FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HOSPITAL ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-982-9081
Mailing Address - Street 1:961 EAST WINTHROPE AVENUE
Mailing Address - Street 2:
Mailing Address - City:MILLEN
Mailing Address - State:GA
Mailing Address - Zip Code:30442-1839
Mailing Address - Country:US
Mailing Address - Phone:478-982-9081
Mailing Address - Fax:478-982-8843
Practice Address - Street 1:961 EAST WINTHROPE AVENUE
Practice Address - Street 2:
Practice Address - City:MILLEN
Practice Address - State:GA
Practice Address - Zip Code:30442-1839
Practice Address - Country:US
Practice Address - Phone:478-982-9081
Practice Address - Fax:478-982-8843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARHCS001178261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA118513Medicare ID - Type UnspecifiedRURAL HEALTH CLINIC