Provider Demographics
NPI:1750481982
Name:DEKALB COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:DEKALB COUNTY BOARD OF HEALTH
Other - Org Name:TO VINSON HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DISTRICT DIRECTOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-294-3787
Mailing Address - Street 1:445 WINN WAY
Mailing Address - Street 2:PO BOX 987
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1707
Mailing Address - Country:US
Mailing Address - Phone:404-294-3701
Mailing Address - Fax:404-508-7862
Practice Address - Street 1:440 WINN WAY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1715
Practice Address - Country:US
Practice Address - Phone:404-294-3762
Practice Address - Fax:404-508-7752
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEKALB COUNTY BOARD OF HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-25
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA163WC0400X, 251K00000X, 251X00000X, 261QF0400X
251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251K00000XAgenciesPublic Health or WelfareGroup - Single Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty
No251X00000XAgenciesSupports Brokerage
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)