Provider Demographics
NPI:1497972954
Name:HALL COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:HALL COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN PRIMARY CARE CLINIC
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:POWERS
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:770-532-5337
Mailing Address - Street 1:PO BOX 907411
Mailing Address - Street 2:2515 RAMSEY CIRCLE
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-0907
Mailing Address - Country:US
Mailing Address - Phone:770-654-2010
Mailing Address - Fax:770-532-5341
Practice Address - Street 1:1290 ATHENS ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30507-7000
Practice Address - Country:US
Practice Address - Phone:770-532-5337
Practice Address - Fax:770-532-5341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN053501261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local