NPIMap

Organization Active NPI

Hospital Authority of Candler County

  • Rural Health Clinic/Center
  • Metter, GA
National Provider Identifier
1831728005
Registry record updated Jul 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
HOSPITAL AUTHORITY OF CANDLER COUNTY
Practice address
637 S. Lewis St.
Metter, GA 30439
Phone
(912) 685-5741
NPI assigned
Apr 8, 2020
Organization subpart
Yes
Parent organization
HOSPITAL AUTHORITY OF CANDLER COUNTYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 20, 2023

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
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

637 S. Lewis St.
Metter, GA 30439

Mailing address

PO Box 597
Metter, GA 30439-0597

Other names 1

  • Candler Family Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240219000543 GA Part A Provider - Rural Health Clinic 5294623948 Practice locations: Metter, GA

Rural health clinic certification: CCN 118586

Legal name
HOSPITAL AUTHORITY OF CANDLER COUNTY
Doing business as
CANDLER FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 3, 2024
Last certification
Dec 3, 2024
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
637 South Lewis Street
Metter, GA 30439-5128
Related CCNs
111334

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

Other NPIs with the same Medicare PAC ID 3

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
11D2288130Hospital Authority of Candler County637 South Lewis Street, Metter, GA 30439Certificate of waiverAug 21, 2027

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

637 S Lewis St
Metter, GA 30439
Phone (912) 685-1800

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Grant Lanier Individual Corporate DirectorBoard Member May 12, 2023
Y'Lonne Hodges Individual Corporate DirectorBoard Member Jan 19, 2021
Marsha Holloway Individual Corporate OfficerVice Chairman of the Board Jan 27, 2021
Corporate DirectorVice Chairman of the Board Jan 27, 2021
Brian Wood Individual Corporate OfficerChairman of the Board Jan 1, 2015
Corporate DirectorChairman of the Board Jan 1, 2015
Pamela Smith Individual Corporate DirectorBoard Member Apr 1, 2019
Hospital Authority of Candler County Organization, Metter, GA Non-profit 5% Or Greater Direct Ownership Interest Oct 1, 2023 100%
Operational/Managerial Control Oct 1, 2023 100%
Willuck Bennett Individual Corporate OfficerCfo Jun 3, 2019
W-2 Managing EmployeeCfo Jun 3, 2019
Rocker Hartley Individual Corporate OfficerSecretary Feb 1, 2019
Corporate DirectorSecretary Feb 1, 2019
Terry Manuel Individual Corporate DirectorBoard Member Jan 1, 2020

Owners & managing parties with NPI records 3

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
Candler County HospitalMetter, GA, CCN 111334 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 9, 2007
Candler County HospitalMetter, GA, CCN 11Z334 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 9, 2007

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 39

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

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1586304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689811200000",
    "number": "1831728005",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "637 S. LEWIS ST.",
            "city": "METTER",
            "state": "GA",
            "postal_code": "30439",
            "telephone_number": "912-685-5741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPITAL AUTHORITY OF CANDLER COUNTY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HOSPITAL AUTHORITY OF CANDLER COUNTY",
        "enumeration_date": "2020-04-08",
        "last_updated": "2023-07-20",
        "certification_date": "2023-07-17",
        "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": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Candler Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Candler Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Metter, GA

Sources for this page

Verify at the official NPI Registry.