Provider Demographics
NPI:1184790107
Name:FULTON COUNTY HEALTH DEPT
Entity type:Organization
Organization Name:FULTON COUNTY HEALTH DEPT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LASHONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON-CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-613-1220
Mailing Address - Street 1:99 JESSE HILL JR. DRIVE
Mailing Address - Street 2:STE 402
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303
Mailing Address - Country:US
Mailing Address - Phone:404-613-1220
Mailing Address - Fax:404-224-5235
Practice Address - Street 1:2805 METROPOLITAN PKWY SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-7913
Practice Address - Country:US
Practice Address - Phone:404-612-4111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA740260459AMedicaid