Provider Demographics
NPI:1598759607
Name:DOUGHERTY COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:DOUGHERTY COUNTY BOARD OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT HEALTH DIRECTOR, MD
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:RUIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-352-4275
Mailing Address - Street 1:PO BOX 3048
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31706-3048
Mailing Address - Country:US
Mailing Address - Phone:229-638-6424
Mailing Address - Fax:229-430-6340
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:229-430-6300
Practice Address - Fax:229-430-6340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-02
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300036345DMedicaid
GA000456475EMedicaid
GA000881834BMedicaid
GA000442879AMedicaid
GA000052049FMedicaid
GA000442879AMedicaid