Provider Demographics
NPI:1679136642
Name:GLYNN COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:GLYNN COUNTY BOARD OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-644-5201
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:912-644-5201
Mailing Address - Fax:912-349-2326
Practice Address - Street 1:420 MALL BLVD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-4888
Practice Address - Country:US
Practice Address - Phone:912-644-5200
Practice Address - Fax:912-349-2329
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GLYNN COUNTY BOARD OF HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000456508FMedicaid