Provider Demographics
NPI:1447241591
Name:EARLY COUNTY HEALTH DEPT
Entity Type:Organization
Organization Name:EARLY COUNTY HEALTH DEPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:TREISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-248-3055
Mailing Address - Street 1:618 FLOWERS DR
Mailing Address - Street 2:
Mailing Address - City:BLAKELY
Mailing Address - State:GA
Mailing Address - Zip Code:39823-2804
Mailing Address - Country:US
Mailing Address - Phone:229-723-3707
Mailing Address - Fax:229-723-8246
Practice Address - Street 1:618 FLOWERS DR
Practice Address - Street 2:
Practice Address - City:BLAKELY
Practice Address - State:GA
Practice Address - Zip Code:39823-2804
Practice Address - Country:US
Practice Address - Phone:229-723-3707
Practice Address - Fax:229-723-8246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00456475FMedicaid
GA00442879EMedicaid
GA00052049GMedicaid
GA00442879GMedicaid