1124099908 NPI number — NEWTON COUNTY HEALTH DEPARTMENT

Table of content: (NPI 1124099908)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124099908 NPI number — NEWTON COUNTY HEALTH DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEWTON COUNTY HEALTH DEPARTMENT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124099908
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
324 W PIKE ST
Provider Second Line Business Mailing Address:
P.O. BOX 897
Provider Business Mailing Address City Name:
LAWRENCEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30045-4880
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-339-4260
Provider Business Mailing Address Fax Number:
770-963-6322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8203 HAZELBRAND RD NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30014-1510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-786-9086
Provider Business Practice Location Address Fax Number:
770-786-0715
Provider Enumeration Date:
01/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HUDSON
Authorized Official First Name:
VERONICA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
BILLING SUPERVISOR
Authorized Official Telephone Number:
678-442-6884

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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