Provider Demographics
NPI:1023045093
Name:MACON COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:MACON 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:P.O. BOX 729
Mailing Address - Street 2:
Mailing Address - City:OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:31068
Mailing Address - Country:US
Mailing Address - Phone:478-472-8121
Mailing Address - Fax:
Practice Address - Street 1:110 CHATHAM STREET
Practice Address - Street 2:
Practice Address - City:OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:31068
Practice Address - Country:US
Practice Address - Phone:478-472-8121
Practice Address - Fax:
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
GA00058726HMedicaid
GA00457729CMedicaid
GA00052082GMedicaid
GAFLU093Medicare PIN