1104828573 NPI number — LAMAR COUNTY HEALTH DEPARTMENT

Table of content: (NPI 1104828573)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104828573 NPI number — LAMAR COUNTY HEALTH DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAMAR 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:
6
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:
1104828573
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 ACADEMY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARNESVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30204-3526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-358-1483
Provider Business Mailing Address Fax Number:
770-358-1258

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 ACADEMY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARNESVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30204-3526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-358-1483
Provider Business Practice Location Address Fax Number:
770-358-1258
Provider Enumeration Date:
08/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ELLINGTON
Authorized Official First Name:
RHONDA
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING SUPERVISOR
Authorized Official Telephone Number:
706-298-7732

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , with the licence number:  D28997 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP0905X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000456453U , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00052093H , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003112511I , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003288785A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000784319A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000656345A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000456453AA , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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