Organization
CLINCH COUNTY HOSPITAL AUTHORITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANGELA P. AMMONS (ADMINISTRATOR)
(912) 487-5211
Entity
Organization
Contact information
Practice address
1050 VALDOSTA HWY, HOMERVILLE, GA 31634-2418
(912) 487-5211
(912) 487-4334
Mailing address
1050 VALDOSTA HWY, P.O. BOX 516, HOMERVILLE, GA 31634-2418
(912) 487-5211
(912) 487-4334
Taxonomy
Speciality
Code
Description
License number
State
282NC0060X
Critical Access Hospital
Primary
032-634
GA
341600000X
Ambulance
032-01
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00000415A
—
GA
Enumeration date
12/21/2005
Last updated
12/20/2017
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