Provider Demographics
NPI:1457440364
Name:PIKE COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:PIKE COUNTY BOARD OF HEALTH
Other - Org Name:PIKE COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-298-7732
Mailing Address - Street 1:PO BOX 342
Mailing Address - Street 2:541 GRIFFIN STREET
Mailing Address - City:ZEBULON
Mailing Address - State:GA
Mailing Address - Zip Code:30295-0342
Mailing Address - Country:US
Mailing Address - Phone:770-567-8972
Mailing Address - Fax:770-567-3531
Practice Address - Street 1:541 GRIFFIN STREET
Practice Address - Street 2:
Practice Address - City:ZEBULON
Practice Address - State:GA
Practice Address - Zip Code:30295
Practice Address - Country:US
Practice Address - Phone:770-567-8972
Practice Address - Fax:770-567-3531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000784407AMedicaid
GA000638921AMedicaid
GA612941250AMedicaid
GA000456453LMedicaid
GA00052093TMedicaid