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The Baxley and Appling County Hospital Authority

Organization Active NPI Rural Health Clinic/Center · Baxley, GA

NPI 1073752143 · NPPES record last updated Jan 14, 2026

Key facts

NPI
1073752143
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
License
001-502 (GA)
Legal business name
THE BAXLEY AND APPLING COUNTY HOSPITAL AUTHORITY
Practice address
105 E Tollison St Ste B
Baxley, GA 31513-0150
Phone
(912) 367-0102
Fax
(912) 367-9966
NPI assigned
Feb 13, 2009
Organization subpart
Yes
Parent organization (as reported)
THE BAXLEY AND APPLING COUNTY HOSPITAL AUTHORITY

Authorized official

Name
Marie Barnes
Title
Credentialing Coordinator
Phone
(912) 367-9841

Owners & managing parties with NPI records 7

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Owned or controlled facilities with NPI records 6

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 17

Organizations that report the same tax identification number in the National Provider Directory.

Facilities connected through Provider of Services related, parent or unit certification numbers.

Facilities with the same owner 6

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners 127

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 127

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D0943174Appling Medical Group- Dr O V Fernando
105 E Tollison Street, Suite B, Baxley, GA 31513		Provider-performed microscopyMar 23, 2028

Medicare participation

Medicare fee-for-service enrollment
Enrolled in GA

Rural health clinic certification: CCN 118520

Legal name
THE BAXLEY AND APPLING COUNTY HOSPITAL AUTHORITY
Doing business as
APPLING MEDICAL GROUP
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 29, 2009
Last certification
Sep 9, 2021
Ownership / control type
2B
Organization structure
Other · Non-profit
Incorporated
Feb 5, 1952 in GA
Enrollment address
105 E Tollison St
Ste B
Baxley, GA 31513-0150
Related CCNs
110071

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Andrea Pierce Graham
Individual 		Corporate Director Jul 30, 2021
W-2 Managing Employee
Ceo		 Jul 30, 2021 100%
Pam Dean
Individual 		W-2 Managing Employee Jun 3, 1996
Cindy Tomberlin
Individual 		Corporate Officer
Chair of Board		 Jul 1, 2021 100%
The Baxley and Appling County Hospital Authority
Organization · Baxley, GA 		5% Or Greater Direct Ownership Interest Feb 18, 2009

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Appling Healthcare System
Baxley, GA · CCN 110071		 Hospital Operational/Managerial Control Nov 6, 2007
Appling Healthcare System
Baxley, GA · CCN 11S071		 Hospital Operational/Managerial Control Nov 6, 2007
Appling Healthcare System
Baxley, GA · CCN 11U071		 Hospital Operational/Managerial Control Nov 6, 2007
Appling Nursing and Rehabilitation Pavilion
Baxley, GA · CCN 115262		 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Jan 1, 2000
Jan 1, 2000
Appling Pediatrics
Baxley, GA · CCN 118521		 Rural health clinic 5% Or Greater Direct Ownership Interest Feb 18, 2009
South Georgia Medical Associates
Baxley, GA · CCN 118522		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 18, 2009

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20090602000334 GA Part a Provider - Rural Health Clinic 8426957325 Practice locations: Baxley, GA

National Provider Directory

Tax ID family
Appling Healthcare Syst (18 organizations share this tax ID)
Part of
Appling Healthcare Syst

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 001-502 GA Yes

Addresses

Primary practice location

105 E Tollison St Ste B
Baxley, GA 31513-0150

Mailing address

PO Box 2070
Baxley, GA 31515-2070
Phone (912) 367-0102

Other names

  • Appling Medical Group Doing business as

Other providers in Baxley, GA

All providers in Baxley, GA · Rural Health Clinic/Center in Georgia

Sources for this page

Verify at the official NPI Registry.