1851381156 NPI number — GLYNN COUNTY GEORGIA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851381156 NPI number — GLYNN COUNTY GEORGIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GLYNN COUNTY GEORGIA
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:
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:
1851381156
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2026
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:
121 PUBLIC SAFETY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRUNSWICK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31525-8906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-554-7779
Provider Business Practice Location Address Fax Number:
912-297-3695
Provider Enumeration Date:
10/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SHORB
Authorized Official First Name:
TERESA
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
ADMINISTRATIVE SUPERVISOR
Authorized Official Telephone Number:
912-554-7779

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  063-01 , 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: 000002703A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590003739 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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