Provider Demographics
NPI:1508894171
Name:CHARLTON COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:CHARLTON COUNTY BOARD OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSO
Authorized Official - Prefix:
Authorized Official - First Name:STARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-427-2042
Mailing Address - Street 1:PO BOX 605
Mailing Address - Street 2:
Mailing Address - City:FOLKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:31537-0605
Mailing Address - Country:US
Mailing Address - Phone:912-496-2561
Mailing Address - Fax:912-496-2623
Practice Address - Street 1:2587 THIRD ST
Practice Address - Street 2:
Practice Address - City:FOLKSTON
Practice Address - State:GA
Practice Address - Zip Code:31537-8964
Practice Address - Country:US
Practice Address - Phone:912-796-2561
Practice Address - Fax:912-496-2623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000052027HMedicaid
GA000442967HMedicaid
GA000457784HMedicaid
GA000453098HMedicaid
GA000777587AMedicaid
GA202G604345OtherMEDICARE PTAN
GA000457784HMedicaid