Provider Demographics
NPI:1699769166
Name:HOSPITAL AUTHORITY OF RANDOLPH COUNTY
Entity type:Organization
Organization Name:HOSPITAL AUTHORITY OF RANDOLPH COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HARC BOARD CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHATLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-209-1242
Mailing Address - Street 1:361 RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:CUTHBERT
Mailing Address - State:GA
Mailing Address - Zip Code:39840-6127
Mailing Address - Country:US
Mailing Address - Phone:229-312-6711
Mailing Address - Fax:229-732-6759
Practice Address - Street 1:361 RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:CUTHBERT
Practice Address - State:GA
Practice Address - Zip Code:39840-6127
Practice Address - Country:US
Practice Address - Phone:229-312-6711
Practice Address - Fax:229-732-6759
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPITAL AUTHORITY OF RANDOLPH COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-09
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048502208600000X
GA040908208D00000X
GA042910208D00000X
GA053465208D00000X
GA048852208D00000X
GAPHH003499282N00000X
282NC0060X, 333600000X, 3336I0012X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical AccessGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Multi-Specialty
No333600000XSuppliersPharmacyGroup - Multi-Specialty
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00001427AMedicaid
GA111300Medicare ID - Type Unspecified
GAHOSP3Medicare PIN