Provider Demographics
NPI:1396045431
Name:THE HOSPITAL AUTHORITY OF MILLER COUNTY
Entity type:Organization
Organization Name:THE HOSPITAL AUTHORITY OF MILLER COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAU
Authorized Official - Suffix:
Authorized Official - Credentials:BACH PHARMACY
Authorized Official - Phone:229-758-4949
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:209 N CUTHBERT STREET
Mailing Address - City:COLQUITT
Mailing Address - State:GA
Mailing Address - Zip Code:39837-0007
Mailing Address - Country:US
Mailing Address - Phone:229-758-4245
Mailing Address - Fax:229-752-9715
Practice Address - Street 1:209 N CUTHBERT ST
Practice Address - Street 2:
Practice Address - City:COLQUITT
Practice Address - State:GA
Practice Address - Zip Code:39837-3518
Practice Address - Country:US
Practice Address - Phone:229-758-4245
Practice Address - Fax:229-758-9715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X
GAPHRE0089343336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2013346OtherPK
GA003100181AMedicaid