Provider Demographics
NPI:1366450934
Name:PEACH COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:PEACH COUNTY BOARD OF HEALTH
Other - Org Name:PEACH COUNTY HEALTH DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:DISTRICT HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-751-6303
Mailing Address - Street 1:201 2ND ST STE 1100
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-6328
Mailing Address - Country:US
Mailing Address - Phone:478-297-5190
Mailing Address - Fax:478-751-6099
Practice Address - Street 1:503 BLUEBIRD BLVD
Practice Address - Street 2:
Practice Address - City:FORT VALLEY
Practice Address - State:GA
Practice Address - Zip Code:31030-5096
Practice Address - Country:US
Practice Address - Phone:478-825-6939
Practice Address - Fax:478-825-6792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00051961KMedicaid
GA000733224AMedicaid
GA003185983AMedicaid
GA003186608AMedicaid
GA000733224AMedicaid
GA00219381EMedicaid
GA00733224AMedicaid
GA003185983AMedicaid
GA00452944IMedicaid
GA600001261Medicare PIN