Provider Demographics
NPI:1578644522
Name:CHATHAM COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:CHATHAM COUNTY BOARD OF HEALTH
Other - Org Name:CHATHAM COUNTY HEALTH DEPARTMENT-MIDTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DISTRICT BILLING DEPT COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-262-2347
Mailing Address - Street 1:150 SCRANTON CONNECTOR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-0540
Mailing Address - Country:US
Mailing Address - Phone:912-262-2347
Mailing Address - Fax:912-262-3036
Practice Address - Street 1:1602 DRAYTON ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-7526
Practice Address - Country:US
Practice Address - Phone:912-262-2347
Practice Address - Fax:912-262-3036
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHATHAM COUNTY BOARD OF HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-18
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000459786AMedicaid
GAFLU230OtherMEDICARE ID
GA000456497EMedicaid
GA0000637425BMedicaid
GA000654376AMedicaid
GA000459786AMedicaid