Provider Demographics
NPI:1326046582
Name:EFFINGHAM COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:EFFINGHAM COUNTY BOARD OF HEALTH
Other - Org Name:EFFINGHAM COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:A
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-262-2347
Mailing Address - Street 1:150 SCRANTON CONNECTOR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-0540
Mailing Address - Country:US
Mailing Address - Phone:912-262-2347
Mailing Address - Fax:912-262-3036
Practice Address - Street 1:802 HWY 119 SOUTH
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:GA
Practice Address - Zip Code:31329-0350
Practice Address - Country:US
Practice Address - Phone:912-262-2347
Practice Address - Fax:912-262-3036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300019846LMedicaid
GA300036705ADMedicaid
GA000654376CMedicaid
GA300019846CMedicaid
GA000456497DMedicaid
GA300019846GMedicaid
GAFLU233Medicare PIN
GAFLU233Medicare PIN