1497807366 NPI number — BOARD OF HEALTH WHITE COUNTY

Table of content: (NPI 1497807366)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497807366 NPI number — BOARD OF HEALTH WHITE COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOARD OF HEALTH WHITE COUNTY
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:
1497807366
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1331 HELEN HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30528-2834
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-865-2191
Provider Business Mailing Address Fax Number:
706-865-7745

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1331 HELEN HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30528-2834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-865-2191
Provider Business Practice Location Address Fax Number:
706-865-7745
Provider Enumeration Date:
01/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
POLLARD
Authorized Official First Name:
STACY
Authorized Official Middle Name:
T
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
706-865-2191

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , 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: 000924679B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000051972N , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000058638A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000442945O , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000456442A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10044067 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 342691 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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