Provider Demographics
NPI:1942324181
Name:BOARD OF HEALTH WALTON COUNTY
Entity Type:Organization
Organization Name:BOARD OF HEALTH WALTON COUNTY
Other - Org Name:WEST WALTON HEALTH CLINIC
Other - Org Type:Other Name
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 1:4385 PECAN ST
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-2637
Mailing Address - Country:US
Mailing Address - Phone:770-466-1789
Mailing Address - Fax:770-466-1321
Practice Address - Street 1:4385 PECAN ST
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-2637
Practice Address - Country:US
Practice Address - Phone:770-466-1789
Practice Address - Fax:770-466-1321
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOARD OF HEALTH WALTON COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-16
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local