Provider Demographics
NPI:1851432173
Name:FLOYD COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:FLOYD COUNTY HEALTH DEPARTMENT
Other - Org Name:NW GA SPECIALTY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:SELLERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-295-6704
Mailing Address - Street 1:16 EAST 12TH STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-4720
Mailing Address - Country:US
Mailing Address - Phone:706-295-6701
Mailing Address - Fax:706-295-6697
Practice Address - Street 1:16 EAST 12TH STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-4720
Practice Address - Country:US
Practice Address - Phone:706-295-6701
Practice Address - Fax:706-295-6697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025271261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000428205DMedicaid
GA000505733DMedicaid