Provider Demographics
NPI:1689981326
Name:EMANUEL COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:EMANUEL COUNTY BOARD OF HEALTH
Other - Org Name:EMANUEL COUNTY HEALTH DEPT ADRIAN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:DEBRA
Authorized Official - Last Name:UNDERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-667-4265
Mailing Address - Street 1:50 HIGHWAY 56 N
Mailing Address - Street 2:
Mailing Address - City:SWAINSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30401-4441
Mailing Address - Country:US
Mailing Address - Phone:478-237-7501
Mailing Address - Fax:478-289-2501
Practice Address - Street 1:101 NORA BLVD
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:GA
Practice Address - Zip Code:31002
Practice Address - Country:US
Practice Address - Phone:478-668-3436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-01
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000456552UMedicaid
GA003104487AMedicaid
GA600001695OtherRAILROAD MEDICARE
GA000456552ACMedicaid
GA000456552UMedicaid