NPIMap

Organization Active NPI

Hospital Authority of Jenkins County

  • Psychiatric Hospital Unit
  • Millen, GA
National Provider Identifier
1457935504
Registry record updated May 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
Legal business name
HOSPITAL AUTHORITY OF JENKINS COUNTY
Practice address
931 E Winthrope Ave
Millen, GA 30442-1839
Phone
(478) 982-4221
NPI assigned
May 5, 2021
Last updated
May 5, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2021

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

Authorized official

Name
Antoine Poythress
Title
Ceo
Phone
(478) 357-8055

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X NU Primary

Addresses

Primary practice location

931 E Winthrope Ave
Millen, GA 30442-1839

Mailing address

931 E Winthrope Ave
Millen, GA 30442-1839

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040401000747 GA Part B Supplier - Clinic/Group Practice 5193717833 Receives reassigned benefits from 3 practitioners
1 other NPI on this enrollment
Practice locations: Millen, GA
O20220913004162 GA Part A Provider - Critical Access Hospital 5193717833 Practice locations: Millen, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1457935504. Details of each certification follow.

Hospital certification: CCN 11M311

Legal name
HOSPITAL AUTHORITY OF JENKINS COUNTY
Organization structure
OtherProprietary
Incorporated
Jul 15, 1968 in GA
Enrollment address
931 E Winthrope Ave
Millen, GA 30442-1839
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

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
Robert Fuller Individual Other Jul 1, 2021
Antoine Poythress Individual Corporate OfficerCeo Jul 1, 2021
W-2 Managing EmployeeCeo Jul 1, 2021
Jeffrey Brantley Individual Other Jul 1, 2021
Hospital Authority of Jenkins County Organization, Millen, GA 5% Or Greater Direct Ownership Interest Jul 1, 2021 7%

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Jenkins County Medical CenterMillen, GA, CCN 11Z311 Hospital 5% Or Greater Direct Ownership Interest
Operational/Managerial Control (100%)		 Jul 1, 2021
Oct 7, 2024
Jenkins County Family MedicineMillen, GA, CCN 111311 Hospital 5% Or Greater Direct Ownership Interest Jul 1, 2021

Owned or controlled facilities with NPI records 2

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

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1620172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620172800000",
    "number": "1457935504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "931 E WINTHROPE AVE",
            "city": "MILLEN",
            "state": "GA",
            "postal_code": "304421839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "931 E WINTHROPE AVE",
            "city": "MILLEN",
            "state": "GA",
            "postal_code": "304421839",
            "telephone_number": "478-982-4221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPITAL AUTHORITY OF JENKINS COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-05",
        "last_updated": "2021-05-05",
        "certification_date": "2021-05-05",
        "status": "A",
        "authorized_official_last_name": "POYTHRESS",
        "authorized_official_first_name": "ANTOINE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "478-357-8055"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Millen, GA

Sources for this page

Verify at the official NPI Registry.