Provider Demographics
NPI:1083713507
Name:PAULDING COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:PAULDING COUNTY BOARD OF HEALTH
Other - Org Name:PAULDING COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:VOCCIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-295-6704
Mailing Address - Street 1:451 JIMMY CAMPBELL PKWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-5500
Mailing Address - Country:US
Mailing Address - Phone:770-443-7881
Mailing Address - Fax:770-443-7885
Practice Address - Street 1:451 JIMMY CAMPBELL PKWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-5500
Practice Address - Country:US
Practice Address - Phone:770-443-7881
Practice Address - Fax:770-443-7885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000051829IMedicaid
GAGAA16394OtherMEDICARE SUBMITTER
GA202G606679Medicare PIN
GA000051829IMedicaid