Provider Demographics
NPI:1891859252
Name:UPSON COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:UPSON COUNTY BOARD OF HEALTH
Other - Org Name:UPSON COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-298-7732
Mailing Address - Street 1:314 E LEE ST
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-4122
Mailing Address - Country:US
Mailing Address - Phone:706-647-7148
Mailing Address - Fax:706-647-7194
Practice Address - Street 1:314 E LEE ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-4122
Practice Address - Country:US
Practice Address - Phone:706-647-7148
Practice Address - Fax:706-647-3372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251K00000X
261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00784341AMedicaid
GA00456453QMedicaid
GA00052093MMedicaid
GA00643288AMedicaid
GA00643288AMedicaid
GA319145OtherWELLCARE
GA21305936AMedicaid
GA00643288AMedicaid