Provider Demographics
NPI: | 1912319997 |
---|---|
Name: | EMANUEL COUNTY HOSPITAL AUTHORITY |
Entity Type: | Organization |
Organization Name: | EMANUEL COUNTY HOSPITAL AUTHORITY |
Other - Org Name: | TWIN CITY FAMILY MEDICAL CLINIC |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CFO |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | STEVE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | KING |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 478-289-1376 |
Mailing Address - Street 1: | PO BOX 879 |
Mailing Address - Street 2: | |
Mailing Address - City: | SWAINSBORO |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 30401-0879 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 478-289-1303 |
Mailing Address - Fax: | 478-289-7466 |
Practice Address - Street 1: | 115 GILLIKIN ST |
Practice Address - Street 2: | |
Practice Address - City: | TWIN CITY |
Practice Address - State: | GA |
Practice Address - Zip Code: | 30471-3989 |
Practice Address - Country: | US |
Practice Address - Phone: | 478-763-3036 |
Practice Address - Fax: | 478-763-4060 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-05-27 |
Last Update Date: | 2015-09-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QR1300X | Ambulatory Health Care Facilities | Clinic/Center | Rural Health | Group - Single Specialty |