1841200441 NPI number — MCINTOSH COUNTY COMMISSIONERS OF ROADS & REVENUE

Table of content: (NPI 1841200441)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841200441 NPI number — MCINTOSH COUNTY COMMISSIONERS OF ROADS & REVENUE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCINTOSH COUNTY COMMISSIONERS OF ROADS & REVENUE
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:
1841200441
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 429
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27023-0429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-200-1191
Provider Business Mailing Address Fax Number:
336-740-9793

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1019 PRODUCTION ROW SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DARIEN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31305-6151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-832-6265
Provider Business Practice Location Address Fax Number:
952-985-5671
Provider Enumeration Date:
08/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WALLACE
Authorized Official First Name:
FRANKLIN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
912-437-6671

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  098-03 , 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: 00327225A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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