Basic Information
| Provider Information | |||||||||
| NPI: | 1144838574 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BURKE COUNTY HOSPITAL AUTHORITY | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 351 S LIBERTY ST | ||||||||
| Address2: | |||||||||
| City: | WAYNESBORO | ||||||||
| State: | GA | ||||||||
| PostalCode: | 308309686 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065544435 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 351 S LIBERTY ST | ||||||||
| Address2: | |||||||||
| City: | WAYNESBORO | ||||||||
| State: | GA | ||||||||
| PostalCode: | 308309686 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065544435 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2020 | ||||||||
| LastUpdateDate: | 07/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DAY | ||||||||
| AuthorizedOfficialFirstName: | KIAH | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING COORD. | ||||||||
| AuthorizedOfficialTelephone: | 7065544435 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
No ID Information.