NPI 1164353405

Bethany Missionary Baptist Church

Organisation PACE Provider Organization Ty Ty, GA

Practice location

Address: 146 Ty Ty Sycamore Rd, Ty Ty, GA 31795-3314
Phone: (678) 986-1436

Authorised official

Name: Samuel Lee Pridgon
Title: Pastor/Ceo
Phone: (678) 986-1436

Registered specialties

PACE Provider Organization Primary

Agencies Taxonomy 251T00000X

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Registry record

NPI: 1164353405
Entity type: Organization
NPI issued: 26 May 2026
Record last updated: 26 May 2026

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.