Provider Demographics
NPI:1225091028
Name:STEPHENS COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:STEPHENS COUNTY BOARD OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:N
Authorized Official - Last Name:WESTFALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-535-5743
Mailing Address - Street 1:64 BOULEVARD STE 102
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-3010
Mailing Address - Country:US
Mailing Address - Phone:706-282-4507
Mailing Address - Fax:706-282-4511
Practice Address - Street 1:64 BOULEVARD STE 102
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-3010
Practice Address - Country:US
Practice Address - Phone:706-282-4507
Practice Address - Fax:706-282-4511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00051972KMedicaid
GA000924679CMedicaid
GA00453109KMedicaid
GA00649437GMedicaid
GA00058638AMedicaid
GA00442945LMedicaid
GA00456442DMedicaid
GA00058638AMedicaid