Provider Demographics
NPI:1326099946
Name:MCDUFFIE COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:MCDUFFIE COUNTY BOARD OF HEALTH
Other - Org Name:MCDUFFIE COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DISTRICT BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:C
Authorized Official - Last Name:NEWTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-667-4265
Mailing Address - Street 1:1916 N LEG RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-4402
Mailing Address - Country:US
Mailing Address - Phone:706-667-4265
Mailing Address - Fax:706-667-4301
Practice Address - Street 1:307 GREENWAY ST
Practice Address - Street 2:
Practice Address - City:THOMSON
Practice Address - State:GA
Practice Address - Zip Code:30824-2721
Practice Address - Country:US
Practice Address - Phone:706-595-1740
Practice Address - Fax:706-595-8503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000453153IMedicaid
GA600000445OtherRAILROAD MEDICARE
GA000456552LMedicaid
GA000676563GMedicaid
GA000051851IMedicaid
GA000453153NMedicaid
GA202G732242Medicare PIN