1396705935 NPI number — MANCHESTER HEALTH DEPARTMENT

Table of content: (NPI 1396705935)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396705935 NPI number — MANCHESTER HEALTH DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MANCHESTER 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:
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:
1396705935
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 W PERRY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31816-1346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-672-4974
Provider Business Mailing Address Fax Number:
66-721-0657

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 W PERRY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31816-1346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-846-3353
Provider Business Practice Location Address Fax Number:
706-846-2674
Provider Enumeration Date:
03/27/2006

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:  REF000026462 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00519054A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00663495A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00456453J , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00784363A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00456453AC , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 750490044A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com