Provider Demographics
NPI:1205889623
Name:JEFFERSON COUNTY BOARD OF HEALTH
Entity type:Organization
Organization Name:JEFFERSON COUNTY BOARD OF HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DISTRICT HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DONOHUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-825-6914
Mailing Address - Street 1:2501 US HIGHWAY # 1 NORTH
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30434
Mailing Address - Country:US
Mailing Address - Phone:478-625-3716
Mailing Address - Fax:478-625-8201
Practice Address - Street 1:2501 U.S. HIGHWAY # 1 NORTH
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:GA
Practice Address - Zip Code:30434
Practice Address - Country:US
Practice Address - Phone:478-625-3716
Practice Address - Fax:478-625-8201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000456552IMedicaid
GA000864652AMedicaid
GA000051851FMedicaid
GA000676563EMedicaid
GA600000312OtherRAILROAD MEDICARE
GAFLU114Medicare PIN