Provider Demographics
NPI:1689665689
Name:SOUTHWEST HEALTH DISTRICT 8-2
Entity Type:Organization
Organization Name:SOUTHWEST HEALTH DISTRICT 8-2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT HEALTH DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:H
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH, MPA
Authorized Official - Phone:229-430-4127
Mailing Address - Street 1:1109 N JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-2022
Mailing Address - Country:US
Mailing Address - Phone:229-430-4127
Mailing Address - Fax:229-430-5143
Practice Address - Street 1:1109 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-2022
Practice Address - Country:US
Practice Address - Phone:229-430-4127
Practice Address - Fax:229-430-5143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00959329AMedicaid
GA00058715AMedicaid
GA00548292AMedicaid
GA00959329AMedicaid