Provider Demographics
NPI:1922037209
Name:EVANS COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:EVANS COUNTY BOARD OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSO
Authorized Official - Prefix:
Authorized Official - First Name:STARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-427-2042
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:CLAXTON
Mailing Address - State:GA
Mailing Address - Zip Code:30417-0366
Mailing Address - Country:US
Mailing Address - Phone:912-739-2088
Mailing Address - Fax:912-739-3975
Practice Address - Street 1:4 N NEWTON ST
Practice Address - Street 2:
Practice Address - City:CLAXTON
Practice Address - State:GA
Practice Address - Zip Code:30417-1756
Practice Address - Country:US
Practice Address - Phone:912-739-2088
Practice Address - Fax:912-739-3975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000442967LMedicaid
GA000052027KMedicaid
GA000777279AMedicaid
GA000457784LMedicaid
GA600000735Medicare ID - Type UnspecifiedRAILROAD BILLING #
GA000442967LMedicaid
GAGRP3489Medicare ID - Type UnspecifiedCOUNTY MDCR BILLING #