Provider Demographics
NPI:1689631715
Name:HOUSTON COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:HOUSTON COUNTY BOARD OF HEALTH
Other - Org Name:THE HOPE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HOPE CENTER MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUINALDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-751-6303
Mailing Address - Street 1:180 EMERY HWY
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-3656
Mailing Address - Country:US
Mailing Address - Phone:478-464-0612
Mailing Address - Fax:478-464-0002
Practice Address - Street 1:180 EMERY HWY
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-3656
Practice Address - Country:US
Practice Address - Phone:478-464-0612
Practice Address - Fax:478-464-0002
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOUSTON COUNTY HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-01
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2083P0901X
GA261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003136039TMedicaid
GA000495547DMedicaid
GA000309878DMedicaid
GA003259332CMedicaid
GA000309878BMedicaid