Provider Demographics
NPI:1780658757
Name:PICKENS COUNTY DEPARTMENT OF PUBLIC HEALTH
Entity Type:Organization
Organization Name:PICKENS COUNTY DEPARTMENT OF PUBLIC HEALTH
Other - Org Name:PICKENS COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DISTRICT HEALTH DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:W
Authorized Official - Last Name:PITTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD JD
Authorized Official - Phone:706-272-2342
Mailing Address - Street 1:60 HEALTH WAY
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-1912
Mailing Address - Country:US
Mailing Address - Phone:706-253-2821
Mailing Address - Fax:706-253-5863
Practice Address - Street 1:60 HEALTH WAY
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-1912
Practice Address - Country:US
Practice Address - Phone:706-253-2821
Practice Address - Fax:706-253-5863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00450282EMedicaid
GA00480642AMedicaid
GA00452911BMedicaid
GA0051994FMedicaid
GA00456519FMedicaid