Provider Demographics
NPI:1689131906
Name:CALHOUN COUNTY DEPT OF FAMILY & CHILDREN SERVICES
Entity Type:Organization
Organization Name:CALHOUN COUNTY DEPT OF FAMILY & CHILDREN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-724-2044
Mailing Address - Street 1:PO BOX 747
Mailing Address - Street 2:
Mailing Address - City:BLAKELY
Mailing Address - State:GA
Mailing Address - Zip Code:39823-0747
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11860 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:BLAKELY
Practice Address - State:GA
Practice Address - Zip Code:39823-2577
Practice Address - Country:US
Practice Address - Phone:229-724-2044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA39866Medicaid