Provider Demographics
NPI:1689684862
Name:COUNTY OF JASPER HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:COUNTY OF JASPER HEALTH DEPARTMENT
Other - Org Name:JASPER COUNTY HEALTH DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:DISTRICT HEALTH DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-751-6303
Mailing Address - Street 1:201 2ND ST STE 1100
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-6328
Mailing Address - Country:US
Mailing Address - Phone:478-297-5190
Mailing Address - Fax:478-751-6099
Practice Address - Street 1:825 EATONTON ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:GA
Practice Address - Zip Code:31064-1062
Practice Address - Country:US
Practice Address - Phone:706-468-6850
Practice Address - Fax:706-468-1422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00051961GMedicaid
GA00460336GMedicaid
GA00733202AMedicaid
GA00456541HMedicaid
GA00219381KMedicaid
GA00456541HMedicaid
GA00460336GMedicaid
GA00219381KMedicaid
GA00733202AMedicaid
GA00051961GMedicaid