1942386289 NPI number — BUTTS COUNTY BOARD OF COMMISSIONERS

Table of content: (NPI 1942386289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942386289 NPI number — BUTTS COUNTY BOARD OF COMMISSIONERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BUTTS COUNTY BOARD OF COMMISSIONERS
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:
BUTTS COUNTY FIRE DEPARTMENT
Provider Other Organization Name Type Code:
3
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:
1942386289
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
625 W 3RD ST
Provider Second Line Business Mailing Address:
SUITE 14
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30233-1881
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-775-8200
Provider Business Mailing Address Fax Number:
770-775-8211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1372 HIGHWAY 42 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLOVILLA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30216-2124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-774-8154
Provider Business Practice Location Address Fax Number:
770-775-8211
Provider Enumeration Date:
10/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSTON
Authorized Official First Name:
WESLEY
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
EMS DIRECTOR
Authorized Official Telephone Number:
770-715-1729

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 003253579A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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