1649208216 NPI number — CANDLER COUNTY BOARD OF HEALTH

Table of content: (NPI 1649208216)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649208216 NPI number — CANDLER COUNTY BOARD OF HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CANDLER 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:
1649208216
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 205
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
METTER
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30439-0205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-685-5765
Provider Business Mailing Address Fax Number:
912-685-7448

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
428 N ROUNTREE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
METTER
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30439-3702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-685-5765
Provider Business Practice Location Address Fax Number:
912-685-7448
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: 000052027G , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000442967G , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000453098G , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000457784G , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000584713A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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