1508894171 NPI number — CHARLTON COUNTY BOARD OF HEALTH

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508894171 NPI number — CHARLTON COUNTY BOARD OF HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLTON COUNTY BOARD OF HEALTH
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:
1508894171
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 605
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOLKSTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31537-0605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-496-2561
Provider Business Mailing Address Fax Number:
912-496-2623

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2587 THIRD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOLKSTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31537-8964
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-796-2561
Provider Business Practice Location Address Fax Number:
912-496-2623
Provider Enumeration Date:
06/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SUTTON
Authorized Official First Name:
STARLA
Authorized Official Middle Name:
Authorized Official Title or Position:
PSO
Authorized Official Telephone Number:
912-427-2042

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)

  • Identifier: 000052027H , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000442967H , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000457784H , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000453098H , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000777587A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 202G604345 . This is a "MEDICARE PTAN" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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