Provider Demographics
NPI:1922163815
Name:SOUTH HEALTH DISTRICT
Entity Type:Organization
Organization Name:SOUTH HEALTH DISTRICT
Other - Org Name:LOWNDES CO BOARD OF HEALTH - LAKE PARK CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DISTRICT ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-245-6439
Mailing Address - Street 1:PO BOX 5147
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31603-5147
Mailing Address - Country:US
Mailing Address - Phone:229-333-5290
Mailing Address - Fax:229-333-7822
Practice Address - Street 1:751 COUNTRY LANE
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:GA
Practice Address - Zip Code:31636
Practice Address - Country:US
Practice Address - Phone:229-559-6470
Practice Address - Fax:229-559-5442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAFLU213Medicare ID - Type UnspecifiedLAKE PARK FLU