NPIMap

Organization Active NPI

Hospital Authority of Mitchell County

Doing business as Medical Group of Mitchell County

  • Rural Health Clinic/Center
  • Camilla, GA
National Provider Identifier
1922211515
Registry record updated Apr 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
101120 Issued in GA
Legal business name
HOSPITAL AUTHORITY OF MITCHELL COUNTY
Doing business as
Medical Group of Mitchell County
Practice address
259 US Highway 19 North
Camilla, GA 31730-1410
Phone
(229) 336-1949
Fax
(229) 336-1436
NPI assigned
May 8, 2007
Last updated
Apr 25, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2019

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

Authorized official

Name
Greg Hembree
Title
Senior VP/Cfo
Phone
(229) 228-2853

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 101120 GA Primary

Addresses

Primary practice location

259 US Highway 19 North
Camilla, GA 31730-1410

Mailing address

920 Cairo Road
Thomasville, GA 31792
Phone (229) 227-5500

Other identifiers 2

IdentifierTypeStateIssuer
841859123CMedicaidGA
11D1056726OtherGACLIA

Other names 1

  • Medical Group of Mitchell County Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070830000426 GA Part A Provider - Rural Health Clinic 6002724598 Practice locations: Camilla, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1922211515. Details of each certification follow.

Rural health clinic certification: CCN 118519

Legal name
HOSPITAL AUTHORITY OF MITCHELL COUNTY
Doing business as
ARCHBOLD PRIMARY CARE CAMILLA
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 27, 2007
Last certification
Jan 14, 2026
Ownership / control type
2B
Organization structure
OtherNon-profit
Enrollment address
259 US Highway 19 N
Camilla, GA 31730-1410
Related CCNs
110018

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

Other NPIs with the same Medicare PAC ID 6

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
11D1056726Medical Group of Mitchell County259 US Highway 19 North, Camilla, GA 31730Provider-performed microscopyJul 23, 2028

National Provider Directory

National Provider Directory
Tax ID family
Mitchell County Hospital10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Ownership & related parties

All disclosed owners & managing parties 23

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

NameRoleSinceShare
Andrea Kidd Collins Individual Corporate DirectorBoard Member Feb 25, 2025
Craig R Wentworth Individual Corporate DirectorBoard Member Oct 1, 2021
Patricia L Barrett Individual W-2 Managing EmployeeDirector Nov 9, 2011
Carla Pearce Individual Corporate OfficerChief Accounting Officer Jul 1, 2021
W-2 Managing EmployeeChief Accounting Officer Aug 23, 1999
Brian J Szwarc Individual Corporate DirectorBoard Member Oct 1, 2021
Sina E. Griffith Individual Corporate DirectorBoard Member Oct 1, 2021
Jason Odell Burnette Individual Corporate DirectorBoard Member Mar 1, 2025
Josh David Simmons Individual Corporate DirectorBoard Member Jan 1, 2023
John D Archbold Memorial Hospital Inc Organization, Thomasville, GA Corporation Operational/Managerial Control Jul 2, 1990 100%
Henry a. Stone Individual Corporate DirectorBoard Member Oct 1, 2021
Timothy Eric Ward Individual Corporate DirectorBoard Member Feb 25, 2025
Karen L Bramblett Individual Corporate DirectorBoard Member Jan 1, 2023
Darcy M Craven Individual Corporate OfficerPresident and Ceo Oct 1, 2021
W-2 Managing EmployeePresident and Ceo Oct 1, 2021
Operational/Managerial ControlPresident and Ceo Oct 1, 2021
Joe S Carnline Individual Corporate DirectorBoard Member Jan 1, 2023
Ashley T. Cason Individual Corporate DirectorBoard Member Jan 1, 2023
Christopher L Daniels Individual Corporate DirectorBoard Member Mar 1, 2025
Loren Rials Individual Corporate OfficerSVP/Cfo Aug 18, 2025
W-2 Managing EmployeeSVP/Cfo Aug 18, 2025
Marvin E. Dawson Individual Corporate DirectorBoard Member Jan 1, 2023
William G Hamil Individual Corporate DirectorBoard Member Jan 28, 2023
Jami Porter Individual Corporate DirectorBoard Member Jan 1, 2023
Gregory Hembree Individual Corporate OfficerSenior Vice President/Cfo Dec 15, 2016
W-2 Managing EmployeeSenior Vice President/Cfo Dec 5, 2016
Jacquelyn V. Santoro Individual Corporate DirectorBoard Member Jan 1, 2023
Jason M Nesmith Individual Corporate DirectorBoard Member Oct 1, 2021

Owners & managing parties with NPI records 13

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

View all 13

Facilities with the same owner 11

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

Practitioners & affiliated clinicians

Practitioners 6

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": "1178582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556150400000",
    "number": "1922211515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 CAIRO ROAD",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "31792",
            "telephone_number": "229-227-5500",
            "fax_number": "229-227-5505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "259 US HIGHWAY 19 NORTH",
            "city": "CAMILLA",
            "state": "GA",
            "postal_code": "317301410",
            "telephone_number": "229-336-1949",
            "fax_number": "229-336-1436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPITAL AUTHORITY OF MITCHELL COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-08",
        "last_updated": "2019-04-25",
        "status": "A",
        "authorized_official_last_name": "HEMBREE",
        "authorized_official_first_name": "GREG",
        "authorized_official_title_or_position": "SENIOR VP/CFO",
        "authorized_official_telephone_number": "229-228-2853"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "GA",
            "license": "101120",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "841859123C",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "11D1056726",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Group of Mitchell County",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Medical Group of Mitchell County",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Camilla, GA

Sources for this page

Verify at the official NPI Registry.