1689981326 NPI number — EMANUEL COUNTY BOARD OF HEALTH

Table of content: (NPI 1689981326)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689981326 NPI number — EMANUEL COUNTY BOARD OF HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMANUEL 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:
1689981326
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 HIGHWAY 56 N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SWAINSBORO
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30401-4441
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-237-7501
Provider Business Mailing Address Fax Number:
478-289-2501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 NORA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ADRIAN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-668-3436
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2010

Additional Information

Authorized Official

Authorized Official Last Name:
UNDERWOOD
Authorized Official First Name:
MARILYN
Authorized Official Middle Name:
DEBRA
Authorized Official Title or Position:
BILLING SUPERVISOR
Authorized Official Telephone Number:
706-667-4265

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: 000456552U , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003104487A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 600001695 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000456552AC , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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