Provider Demographics
NPI:1619059540
Name:SPALDING COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:SPALDING COUNTY BOARD OF HEALTH
Other - Org Name:
Other - Org Type:
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 1:283 CEDARDALE DR
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-5292
Mailing Address - Country:US
Mailing Address - Phone:770-229-4247
Mailing Address - Fax:770-229-3169
Practice Address - Street 1:1007 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-4445
Practice Address - Country:US
Practice Address - Phone:770-467-4740
Practice Address - Fax:770-229-3169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2024-01-25
Deactivation Date:2023-09-13
Deactivation Code:
Reactivation Date:2023-11-20
Provider Licenses
StateLicense IDTaxonomies
251K00000X
GA261QP0905X261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00052093KMedicaid
GA00456453MMedicaid
GA00453263PMedicaid
GA00784385AMedicaid
GA514377013AMedicaid
GA00461744CMedicaid
GA00677234AMedicaid