NPIMap

Organization Active NPI

The Baxley and Appling County Hospital Authority

Doing business as Appling Medical Group

  • Rural Health Clinic/Center
  • Baxley, GA
National Provider Identifier
1073752143
Registry record updated Jan 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
001-502 Issued in GA
Legal business name
THE BAXLEY AND APPLING COUNTY HOSPITAL AUTHORITY
Doing business as
Appling Medical Group
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
Last updated
Jan 14, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
THE BAXLEY AND APPLING COUNTY HOSPITAL AUTHORITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 14, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

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

Specialties & licenses 1

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

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 1

  • Appling Medical Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073752143. Details of each certification follow.

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
OtherNon-profit
Incorporated
Feb 5, 1952 in GA
Enrollment address
105 E Tollison St
Ste B
Baxley, GA 31513-0150
Related CCNs
110071

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

Other NPIs with the same Medicare PAC ID 7

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D0943174Appling Medical Group- Dr O V Fernando105 E Tollison Street, Suite B, Baxley, GA 31513Provider-performed microscopyMar 23, 2028

National Provider Directory

National Provider Directory
Tax ID family
Appling Surgical Center18 organizations share this tax ID, including this one
Part of
Appling Surgical Center

Other organizations with this tax ID 17

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

View all 17

Locations

105 E Tollison St
Ste C
Baxley, GA 31513
Phone (912) 367-4122

301 E Tollison St
Baxley, GA 31513

Ownership & related parties

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 EmployeeCeo Jul 30, 2021 100%
Pam Dean Individual W-2 Managing Employee Jun 3, 1996
Cindy Tomberlin Individual Corporate OfficerChair 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

Owners & managing parties with NPI records 7

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

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

Owned or controlled facilities with NPI records 6

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

Facilities with the same owner 6

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

Practitioners & affiliated clinicians

Practitioners 126

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 126

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1234483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768348800000",
    "number": "1073752143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2070",
            "city": "BAXLEY",
            "state": "GA",
            "postal_code": "315152070",
            "telephone_number": "912-367-0102",
            "fax_number": "912-367-9966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 E TOLLISON ST STE B",
            "city": "BAXLEY",
            "state": "GA",
            "postal_code": "315130150",
            "telephone_number": "912-367-0102",
            "fax_number": "912-367-9966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE BAXLEY AND APPLING COUNTY HOSPITAL AUTHORITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE BAXLEY AND APPLING COUNTY HOSPITAL AUTHORITY",
        "enumeration_date": "2009-02-13",
        "last_updated": "2026-01-14",
        "certification_date": "2026-01-14",
        "status": "A",
        "authorized_official_last_name": "BARNES",
        "authorized_official_first_name": "MARIE",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "912-367-9841"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "GA",
            "license": "001-502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Appling Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Appling Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Baxley, GA

Sources for this page

Verify at the official NPI Registry.