Provider Demographics
NPI:1366492035
Name:EAST CENTRAL HEALTH DISTRICT
Entity Type:Organization
Organization Name:EAST CENTRAL HEALTH DISTRICT
Other - Org Name:RICHMOND COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ECHD BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:DEBRA
Authorized Official - Last Name:UNDERWOOD
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:706-667-4792
Practice Address - Street 1:1916 N LEG RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-4402
Practice Address - Country:US
Practice Address - Phone:706-667-4265
Practice Address - Fax:706-667-4792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000551823BMedicaid
GA000551823AMedicaid
GA003109129AMedicaid
GAFLU104Medicare PIN