Provider Demographics
NPI:1134422140
Name:FULTON COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:FULTON COUNTY HEALTH DEPARTMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HEALTH SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-730-1202
Mailing Address - Street 1:99 JESSE HILL JR DR SE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-3030
Mailing Address - Country:US
Mailing Address - Phone:404-612-8738
Mailing Address - Fax:
Practice Address - Street 1:7741 ROSWELL RD
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30350-4845
Practice Address - Country:US
Practice Address - Phone:404-612-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-13
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511G700318Medicare UPIN
GAGRP 0394Medicare PIN