NPIMap

Organization Active NPI

Hospital Authority of Candler County

  • Primary Care Clinic/Center
  • Pulaski, GA
National Provider Identifier
1316523707
Registry record updated Jan 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
HOSPITAL AUTHORITY OF CANDLER COUNTY
Practice address
107 E Railroad St
Pulaski, GA 30451
Phone
(912) 685-1802
Fax
(912) 685-1803
NPI assigned
Mar 24, 2021
Organization subpart
Yes
Parent organization
HOSPITAL AUTHORITY OF CANDLER COUNTYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 16, 2025

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

Authorized official

Name
Willuck William Bennett
Title
Cfo
Phone
(912) 685-1769

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

107 E Railroad St
Pulaski, GA 30451

Mailing address

PO Box 597
Metter, GA 30439-0597
Phone (912) 685-5715

Other names 1

  • Pulaski Health & Wellness Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040305000415 GA Part B Supplier - Clinic/Group Practice 5294623948 Receives reassigned benefits from 53 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Metter, GA; Pulaski, GA

National Provider Directory

National Provider Directory
Tax ID family
Candler Co Hospital8 organizations share this tax ID, including this one
Part of
Candler Co Hospital

Other organizations with this tax ID 7

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

Locations

380 Cedar St
Metter, GA 30439
Phone (912) 685-1779

12 Doctors St
Metter, GA 30439
Phone (912) 685-1701

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Practitioners 54

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

View all 54

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
11D2318591Hospital Authority of Candler County107 E Railroad Street, Pulaski, GA 30451Certificate of waiverFeb 12, 2027

NPI Registry JSON

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

{
    "created_epoch": "1616544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736985600000",
    "number": "1316523707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 597",
            "city": "METTER",
            "state": "GA",
            "postal_code": "304390597",
            "telephone_number": "912-685-5715",
            "fax_number": "912-685-3461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 E RAILROAD ST",
            "city": "PULASKI",
            "state": "GA",
            "postal_code": "30451",
            "telephone_number": "912-685-1802",
            "fax_number": "912-685-1803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPITAL AUTHORITY OF CANDLER COUNTY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HOSPITAL AUTHORITY OF CANDLER COUNTY",
        "enumeration_date": "2021-03-24",
        "last_updated": "2025-01-16",
        "certification_date": "2024-12-20",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "WILLUCK",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "912-685-1769"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pulaski Health & Wellness",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pulaski Health & Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pulaski, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.