Provider Demographics
NPI:1326049289
Name:CARROLL COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:CARROLL COUNTY BOARD OF HEALTH
Other - Org Name:CARROLL COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-298-7732
Mailing Address - Street 1:1004 NEWNAN RD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30116-6428
Mailing Address - Country:US
Mailing Address - Phone:770-836-6667
Mailing Address - Fax:770-836-6838
Practice Address - Street 1:1004 NEWNAN RD
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30116-6428
Practice Address - Country:US
Practice Address - Phone:770-836-6667
Practice Address - Fax:770-836-6722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163W00000X, 261QP0905X
GA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00784308AMedicaid
GA00456453CMedicaid
GA00461744BMedicaid
GA00052093CMedicaid
GA00784308AMedicaid
GA00456453CMedicaid
GA00052093CMedicaid