Provider Demographics
NPI:1417985060
Name:BULLOCH COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:BULLOCH COUNTY BOARD OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSO
Authorized Official - Prefix:
Authorized Official - First Name:STARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-427-2042
Mailing Address - Street 1:PO BOX 2009
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30459-2009
Mailing Address - Country:US
Mailing Address - Phone:912-764-3800
Mailing Address - Fax:912-871-1901
Practice Address - Street 1:1 W ALTMAN ST
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5212
Practice Address - Country:US
Practice Address - Phone:912-764-3800
Practice Address - Fax:912-871-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000453098FMedicaid
GA000457784FMedicaid
GA000777752AMedicaid
GA000052027FMedicaid
GA000442967FMedicaid
GA000442967FMedicaid
GA000457784FMedicaid
GAGRP3495Medicare ID - Type UnspecifiedCOUNTY MDCR BILLING #