Provider Demographics
NPI:1083665285
Name:GLASCOCK COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:GLASCOCK COUNTY BOARD OF HEALTH
Other - Org Name:GLASCOCK COUNTY HEALTH DEARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DISTRICH HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DONOHUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-825-6914
Mailing Address - Street 1:1916 N LEG RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-4402
Mailing Address - Country:US
Mailing Address - Phone:706-667-4265
Mailing Address - Fax:706-667-4301
Practice Address - Street 1:658 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GIBSON
Practice Address - State:GA
Practice Address - Zip Code:30810-4013
Practice Address - Country:US
Practice Address - Phone:706-598-2061
Practice Address - Fax:706-598-2442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000456552HMedicaid
GA000573361AMedicaid
GAP00094913OtherRAILROAD MEDICARE
GA000051851EMedicaid
GA000676563DMedicaid
GA000573361AMedicaid