Provider Demographics
NPI:1811420375
Name:BOARD OF HEALTH WALTON COUNTY
Entity Type:Organization
Organization Name:BOARD OF HEALTH WALTON COUNTY
Other - Org Name:WALTON COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOGGANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-583-2870
Mailing Address - Street 1:1404 S MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-2816
Mailing Address - Country:US
Mailing Address - Phone:770-207-4125
Mailing Address - Fax:770-207-4129
Practice Address - Street 1:1404 S MADISON AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2816
Practice Address - Country:US
Practice Address - Phone:770-207-4125
Practice Address - Fax:770-207-4129
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOARD OF HEALTH WALTON COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-11
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G703689Medicare PIN