1255384327 NPI number — JENKINS COUNTY HEALTH DEPARTMENT

Table of content: (NPI 1255384327)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255384327 NPI number — JENKINS COUNTY HEALTH DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JENKINS 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:
1255384327
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1916 N LEG RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30909-4402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-667-4265
Provider Business Mailing Address Fax Number:
706-667-4301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
709 VIRGINIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILLEN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-982-2811
Provider Business Practice Location Address Fax Number:
478-982-1589
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DONOHUE
Authorized Official First Name:
LEE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
DISTRICT HEALTH DIRECTOR
Authorized Official Telephone Number:
706-825-6914

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: 000456552J , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000051851G , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000676563L , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000573328A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 600001038 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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