Provider Demographics
NPI:1841818044
Name:HOSPITAL AUTHORITY OF MILLER COUNTY
Entity type:Organization
Organization Name:HOSPITAL AUTHORITY OF MILLER COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-758-3885
Mailing Address - Street 1:209 N CUTHBERT STREET
Mailing Address - Street 2:
Mailing Address - City:COLQUITT
Mailing Address - State:GA
Mailing Address - Zip Code:39837-3518
Mailing Address - Country:US
Mailing Address - Phone:229-758-4212
Mailing Address - Fax:229-758-2668
Practice Address - Street 1:213 DELORES STREET
Practice Address - Street 2:
Practice Address - City:COLQUITT
Practice Address - State:GA
Practice Address - Zip Code:39837
Practice Address - Country:US
Practice Address - Phone:229-758-4836
Practice Address - Fax:229-758-5351
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPITAL AUTHORITY OF MILLER COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-14
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003240033AMedicaid
GAPHRE010846OtherLICENSE NUMBER