Provider Demographics
NPI:1962493890
Name:CALHOUN COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:CALHOUN COUNTY BOARD OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT HEALTH DRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:RUIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-352-4275
Mailing Address - Street 1:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:MORGAN
Mailing Address - State:GA
Mailing Address - Zip Code:39866-0057
Mailing Address - Country:US
Mailing Address - Phone:229-849-2515
Mailing Address - Fax:229-849-2701
Practice Address - Street 1:29040 NORTH BERMUDA STREET
Practice Address - Street 2:
Practice Address - City:MORGAN
Practice Address - State:GA
Practice Address - Zip Code:39866
Practice Address - Country:US
Practice Address - Phone:229-849-2515
Practice Address - Fax:229-849-2701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00561085AMedicaid
GA00052049CMedicaid
GA00452933BMedicaid
GA00456475BMedicaid
GA00452933BMedicaid
GA600001622Medicare ID - Type UnspecifiedRAILROAD MEDICARE