Provider Demographics
NPI:1447743349
Name:DOUGHERTY COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:DOUGHERTY COUNTY BOARD OF HEALTH
Other - Org Name:DOUGHERTY COUNTY HEALTH DEPARTMENT-MDPP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD,DISTRICT HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-352-4275
Mailing Address - Street 1:1710 S SLAPPEY BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-2634
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1710 S SLAPPEY BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-2634
Practice Address - Country:US
Practice Address - Phone:229-638-6424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOUGHERTY COUNTY BOARD OF HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-14
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare