1457541690 NPI number — JENKINS COUNTY BOARD OF COMMISSIONERS

Table of content: (NPI 1457541690)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457541690 NPI number — JENKINS COUNTY BOARD OF COMMISSIONERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JENKINS COUNTY BOARD OF COMMISSIONERS
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:
1457541690
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 797
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILLEN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30442-0797
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-982-2563
Provider Business Mailing Address Fax Number:
478-982-4750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
611 E WINTHROPE 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:
30442-1833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-982-2563
Provider Business Practice Location Address Fax Number:
478-982-4750
Provider Enumeration Date:
07/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CATES
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
478-982-2563

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  08201 , 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: 10070315 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 85030059AA . This is a "MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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