Provider Demographics
NPI:1205800372
Name:FANNIN COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:FANNIN COUNTY HEALTH DEPARTMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:KINSEY
Authorized Official - Suffix:
Authorized Official - Credentials:CPB
Authorized Official - Phone:706-529-5741
Mailing Address - Street 1:95 OUIDA ST
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-4627
Mailing Address - Country:US
Mailing Address - Phone:706-632-3023
Mailing Address - Fax:706-632-5257
Practice Address - Street 1:95 OUIDA STREET
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-4627
Practice Address - Country:US
Practice Address - Phone:706-632-3023
Practice Address - Fax:706-632-5257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000051994CMedicaid
GA000456519CMedicaid
GA000480664AMedicaid
GA000450282CMedicaid