1760490296 NPI number — COUNTY OF HANCOCK HEALTH DEPARTMENT

Table of content: (NPI 1760490296)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760490296 NPI number — COUNTY OF HANCOCK HEALTH DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF HANCOCK HEALTH DEPARTMENT
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:
1760490296
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 2ND ST STE 1100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MACON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31201-6328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-297-5190
Provider Business Mailing Address Fax Number:
478-751-6099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
516 BOLAND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31087-2045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-444-6616
Provider Business Practice Location Address Fax Number:
706-444-5647
Provider Enumeration Date:
08/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCNAIR
Authorized Official First Name:
DANIELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
478-751-6303

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: 00460336E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00456541J , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00733147A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00051961E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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