Provider Demographics
NPI:1679627269
Name:SOUTHWEST GA HEALTH DISTRICT 8 UNIT 2 HIV AIDS
Entity Type:Organization
Organization Name:SOUTHWEST GA HEALTH DISTRICT 8 UNIT 2 HIV AIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AND COLLECTIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRISH
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-758-3359
Mailing Address - Street 1:PO BOX 3048
Mailing Address - Street 2:1710 SOUTH SLAPPEY BLVD
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31706-3048
Mailing Address - Country:US
Mailing Address - Phone:229-430-5140
Mailing Address - Fax:229-430-5142
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:229-430-5140
Practice Address - Fax:229-430-5142
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST GA HEALTH DISTRICT 8 UNIT 2
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-22
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000551614AMedicaid