Provider Demographics
NPI:1134158355
Name:WARE COUNTY BOARD OF HEALTH
Entity type:Organization
Organization Name:WARE COUNTY BOARD OF HEALTH
Other - Org Name:<UNAVAIL>
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 1:604 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-5323
Mailing Address - Country:US
Mailing Address - Phone:912-283-1875
Mailing Address - Fax:912-283-0894
Practice Address - Street 1:604 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-5323
Practice Address - Country:US
Practice Address - Phone:912-283-1875
Practice Address - Fax:912-283-0894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000457784RMedicaid
GA000442967VMedicaid
GA000453098RMedicaid
GA000331196BMedicaid
GA000052027PMedicaid
GA600002587OtherMEDICARE RAILROAD BILLING #
GAGRP1819Medicare ID - Type UnspecifiedCOUNTY MDCR BILLING #
GA000442967VMedicaid