Provider Demographics
NPI:1710027669
Name:WARE COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:WARE COUNTY BOARD OF HEALTH
Other - Org Name:WARE CMS
Other - Org Type:Other Name
Authorized Official - Title/Position:PHSO
Authorized Official - Prefix:
Authorized Official - First Name:STARLA
Authorized Official - Middle Name:P
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-338-5263
Mailing Address - Street 1:715 WARE ST
Mailing Address - Street 2:
Mailing Address - City:BLACKSHEAR
Mailing Address - State:GA
Mailing Address - Zip Code:31516-1723
Mailing Address - Country:US
Mailing Address - Phone:912-807-0301
Mailing Address - Fax:912-807-0299
Practice Address - Street 1:715 WARE ST
Practice Address - Street 2:
Practice Address - City:BLACKSHEAR
Practice Address - State:GA
Practice Address - Zip Code:31516-1723
Practice Address - Country:US
Practice Address - Phone:912-807-0301
Practice Address - Fax:912-807-0299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000457806CMedicaid