Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Bethany Missionary Baptist Church

Organization PACE Provider Organization · NPI 1164353405

Bethany Missionary Baptist Church is a PACE Provider Organization in Ty Ty, Georgia. Registered with an NPI since 2026.

In the registry since
2026

Practice location Address checks out

146 Ty Ty Sycamore Rd
Ty Ty, GA 31795-3314
Phone: (678) 986-1436
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

PACE Provider Organization (primary) Taxonomy 251T00000X

Record details

NPI number1164353405
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Samuel Pridgon — Pastor/Ceo · (678) 986-1436
NPI enumeratedMay 26, 2026
Last updated in NPPESMay 26, 2026
Certification dateMay 26, 2026
Mailing address146 Ty Ty Sycamore Rd, Ty Ty, GA 31795-3314