Provider Demographics
NPI:1104828573
Name:LAMAR COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:LAMAR COUNTY HEALTH DEPARTMENT
Other - Org Name:LAMAR COUNTY BOARD OF HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-298-7732
Mailing Address - Street 1:100 ACADEMY DR
Mailing Address - Street 2:
Mailing Address - City:BARNESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30204-3526
Mailing Address - Country:US
Mailing Address - Phone:770-358-1483
Mailing Address - Fax:770-358-1258
Practice Address - Street 1:100 ACADEMY DR
Practice Address - Street 2:
Practice Address - City:BARNESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30204-3526
Practice Address - Country:US
Practice Address - Phone:770-358-1483
Practice Address - Fax:770-358-1258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAD28997251K00000X
261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000456453UMedicaid
GA00052093HMedicaid
GA003112511IMedicaid
GA003288785AMedicaid
GA000784319AMedicaid
GA000656345AMedicaid
GA000456453AAMedicaid