Provider Demographics
NPI:1235334293
Name:NORTHEAST HEALTH DISTRICT - EPSDT COUNTY
Entity Type:Organization
Organization Name:NORTHEAST HEALTH DISTRICT - EPSDT COUNTY
Other - Org Name:MADISON CO HLTH DEPT DIST 10
Other - Org Type:Other Name
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOGGANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-583-2870
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:DANIELSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30633-0026
Mailing Address - Country:US
Mailing Address - Phone:706-795-2131
Mailing Address - Fax:706-795-5773
Practice Address - Street 1:1424 HIGHWAY 98 W
Practice Address - Street 2:
Practice Address - City:DANIELSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30633-5356
Practice Address - Country:US
Practice Address - Phone:706-795-2131
Practice Address - Fax:706-795-5773
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHEAST HEALTH DISTRICT - EPSDT COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-19
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000051983GMedicaid