Provider Demographics
NPI:1003843079
Name:RANDOLPH COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:RANDOLPH COUNTY BOARD OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ZSOLT
Authorized Official - Middle Name:
Authorized Official - Last Name:KOPPANYI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-321-6300
Mailing Address - Street 1:RT1 BOX 7
Mailing Address - Street 2:
Mailing Address - City:CUTHBERT
Mailing Address - State:GA
Mailing Address - Zip Code:39840
Mailing Address - Country:US
Mailing Address - Phone:229-732-2414
Mailing Address - Fax:229-732-5007
Practice Address - Street 1:410 N. WEBSTER ST.
Practice Address - Street 2:
Practice Address - City:CUTHBERT
Practice Address - State:GA
Practice Address - Zip Code:39840-9704
Practice Address - Country:US
Practice Address - Phone:229-732-2414
Practice Address - Fax:229-732-5007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00052082KMedicaid
GA00058726LMedicaid
GA00052082VMedicaid
GAFLU096Medicare PIN