Hospital Authority of Mitchell County
Organization Active NPI Rural Health Clinic/Center · Camilla, GA
NPI 1366472003 · NPPES record last updated Apr 25, 2019
Key facts
- NPI
- 1366472003
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- 101120 (GA)
- Legal business name
- HOSPITAL AUTHORITY OF MITCHELL COUNTY
- Practice address
- 25 Perry St
Camilla, GA 31730-1852 - Phone
- (229) 336-7472
- Fax
- (229) 336-1661
- NPI assigned
- Jul 4, 2006
- Organization subpart
- No
Authorized official
- Name
- Greg Hembree
- Title
- Senior VP/Cfo
- Phone
- (229) 228-2853
Owners & managing parties with NPI records 13
-
Jason Odell Burnette, M.D.
-
Jason Mark Nesmith, M.D.
-
Brian J Szwarc, M.D.
Other NPIs with the same Medicare PAC ID 6
Corporate family (same tax ID) 9
Member of 1
Facilities with the same owner 11
Practitioners 27
-
Sarah Brooks, NP
-
Mary Anne Bullard, M.D.
-
John Bennett Carico, M.D.
-
Sharif Darwish, M.D.
-
Jenna Roberts Garrett, NURSE PRACTITIONER
-
Magan S Gilliam, NP
-
Cary Carter Newman, M.D.
-
Gregory Louis Roesel, M.D.
-
Stephen A Rubendall Jr., M.D.
-
Jacqueline Smith, M.D.
-
Michael Loy Cobb, MD
-
Ravi Mulchand Giyanani, M.D.
-
Ronnie M. Gundlach, D.O.
-
Michael O'Connor Harding, D.O.
-
Mark Helquist, M.D.
-
Robert Nima Joodi, M.D.
-
Brandi D Lanier, MD
-
Alan G Pratt, MD
-
Anton Shapoval, M.D.
-
Sandra T Willis Curry, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D0909917 | Camilla Pediatric Center, the | Certificate of waiver | Dec 20, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Rural health clinic certification: CCN 113474
- Legal name
- HOSPITAL AUTHORITY OF MITCHELL COUNTY
- Doing business as
- ARCHBOLD PEDIATRICS CAMILLA
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jul 10, 1997
- Last certification
- Mar 2, 2026
- Ownership / control type
- 2B
- Organization structure
- Other · Non-profit
- Enrollment address
- 25 Perry St
Camilla, GA 31730-1852
All disclosed owners & managing parties 23
| Name | Role | Since | Share |
|---|---|---|---|
| Andrea Kidd Collins |
Corporate Director |
Feb 25, 2025 | |
| Craig R Wentworth |
Corporate Director |
Oct 1, 2021 | |
| Patricia L Barrett |
W-2 Managing Employee |
Sep 1, 2006 | |
| Operational/Managerial Control |
Jul 1, 1986 | ||
| Carla Pearce |
Corporate Officer |
Oct 1, 2021 | |
| W-2 Managing Employee |
Oct 1, 2021 | ||
| Brian J Szwarc |
Corporate Director |
Oct 1, 2021 | |
| Sina E. Griffith |
Corporate Director |
Oct 1, 2021 | |
| Jason Odell Burnette |
Corporate Director |
Mar 1, 2025 | |
| Josh David Simmons |
Corporate Director |
Jan 1, 2023 | |
| John D Archbold Memorial Hospital Inc |
Operational/Managerial Control | May 29, 2014 | 100% |
| Henry a. Stone |
Corporate Director |
Oct 1, 2021 | |
| Timothy Eric Ward |
Corporate Director |
Feb 25, 2025 | |
| Karen L Bramblett |
Corporate Director |
Jan 1, 2023 | |
| Darcy M Craven |
Corporate Director |
Oct 1, 2021 | |
| W-2 Managing Employee |
Oct 1, 2021 | ||
| Joe S Carnline |
Corporate Director |
Jan 1, 2023 | |
| Ashley T. Cason |
Corporate Director |
Jan 1, 2023 | |
| Christopher L Daniels |
Corporate Director |
Mar 1, 2025 | |
| Loren Rials |
Corporate Officer |
Aug 18, 2025 | |
| W-2 Managing Employee |
Aug 18, 2025 | ||
| Marvin E. Dawson |
Corporate Director |
Jan 1, 2023 | |
| William G Hamil |
Corporate Director |
Jan 28, 2023 | |
| Jami Porter |
Corporate Director |
Jan 1, 2023 | |
| Gregory Hembree |
Corporate Officer |
Dec 5, 2016 | |
| W-2 Managing Employee |
Dec 5, 2016 | ||
| Jacquelyn V. Santoro |
Corporate Director |
Jan 1, 2023 | |
| Jason M Nesmith |
Corporate Director |
Oct 1, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041109000284 | GA | Part a Provider - Rural Health Clinic | 6002724598 | Practice locations: Camilla, GA |
National Provider Directory
- Tax ID family
- Mitchell County Hosp PH
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | 101120 | GA | Yes |
Addresses
Primary practice location
25 Perry St
Camilla, GA 31730-1852
Mailing address
920 Cairo Rd
Thomasville, GA 31792-4255
Phone (229) 227-5500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000001339G | Medicaid | GA | |
| 11D0909917 | Other | CLIA |
Other names
- The Camilla Pediatric Center
Other providers in Camilla, GA
- Hope Behavioral Health & Addictive Disease Wellness Center
- Hospital Authority of Mitchell County
- Hospital Authority of Mitchell County
- Hospital Authority of Mitchell County
- Hospital Authority of Mitchell County
- Hospital Authority of Mitchell County
- Hospital Authority of Mitchell County
- Hospital Authority of Mitchell County
- Hospital Authority of Mitchell County
- Hospital Authority of Mitchell County
All providers in Camilla, GA · Rural Health Clinic/Center in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 25, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.