1699778530 NPI number — WARREN COUNTY BOARD OF COMMISSIONERS

Table of content: (NPI 1699778530)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699778530 NPI number — WARREN COUNTY BOARD OF COMMISSIONERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WARREN 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:
1699778530
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 46
Provider Second Line Business Mailing Address:
521 MAIN ST
Provider Business Mailing Address City Name:
WARRENTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30828-0046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-465-2221
Provider Business Mailing Address Fax Number:
706-465-1300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
169 HWY 80
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARRENTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30828-8851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-465-3358
Provider Business Practice Location Address Fax Number:
706-465-1300
Provider Enumeration Date:
05/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GRAHAM
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
REESE
Authorized Official Title or Position:
CHAIRMAN, WARREN COUNTY COMMISSIONE
Authorized Official Telephone Number:
706-465-2171

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  149-01 , 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: 58-60000904 . This is a "EIN" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 00003132A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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