Provider Demographics
NPI:1164801460
Name:GEORGIA CORRECTIONAL HEALTH CARE
Entity Type:Organization
Organization Name:GEORGIA CORRECTIONAL HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STATEWIDE MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-249-4971
Mailing Address - Street 1:5899 OLD US 41 N
Mailing Address - Street 2:
Mailing Address - City:HAHIRA
Mailing Address - State:GA
Mailing Address - Zip Code:31632-2427
Mailing Address - Country:US
Mailing Address - Phone:229-794-3388
Mailing Address - Fax:
Practice Address - Street 1:3259 VAL TECH RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-9309
Practice Address - Country:US
Practice Address - Phone:229-249-4971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN135376251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare