Provider Demographics
NPI:1316015407
Name:DODGE COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:DODGE COUNTY BOARD OF HEALTH
Other - Org Name:DODGE COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:SPICER
Authorized Official - Last Name:CHRISTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-275-6545
Mailing Address - Street 1:1121 PLAZA AVE
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-6761
Mailing Address - Country:US
Mailing Address - Phone:478-374-5576
Mailing Address - Fax:478-374-0234
Practice Address - Street 1:1121 PLAZA AVE
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-6761
Practice Address - Country:US
Practice Address - Phone:478-374-5576
Practice Address - Fax:478-374-0234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare