Provider Demographics
NPI:1427575935
Name:FULTON COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:FULTON COUNTY BOARD OF HEALTH
Other - Org Name:NEIGHBORHOOD UNION HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DISTRICT HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:TOOMEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:404-613-1205
Mailing Address - Street 1:10 PARK PLACE SOUTH SE FL 4
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-2913
Mailing Address - Country:US
Mailing Address - Phone:404-613-1205
Mailing Address - Fax:
Practice Address - Street 1:186 SUNSET AVE NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30314-4059
Practice Address - Country:US
Practice Address - Phone:404-612-4665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FULTON COUNTY BOARD OF HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-25
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000457773LMedicaid