1659345718 NPI number — CHEROKEE COUNTY BOARD OF HEALTH

Table of content: (NPI 1659345718)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659345718 NPI number — CHEROKEE COUNTY BOARD OF HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHEROKEE COUNTY BOARD OF HEALTH
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:
1659345718
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1710 WHITEHOUSE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30720-8523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-529-5741
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1219 UNIVETER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-345-7371
Provider Business Practice Location Address Fax Number:
770-345-6978
Provider Enumeration Date:
02/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KINSEY
Authorized Official First Name:
KELLI
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING SUPERVISOR
Authorized Official Telephone Number:
706-529-5757

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: 00456519A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00450282A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00480631A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0051994A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0051994B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00450282B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00456519B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00781173A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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