Provider Demographics
NPI:1255409215
Name:COUNTY OF MONTGOMERY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:COUNTY OF MONTGOMERY HEALTH DEPARTMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:SPICER
Authorized Official - Last Name:CHRISTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-275-6545
Mailing Address - Street 1:PO BOX 212
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:GA
Mailing Address - Zip Code:30445-0212
Mailing Address - Country:US
Mailing Address - Phone:912-583-4602
Mailing Address - Fax:912-583-4085
Practice Address - Street 1:218 WEST BROAD STREET
Practice Address - Street 2:
Practice Address - City:MT. VERNON
Practice Address - State:GA
Practice Address - Zip Code:30445
Practice Address - Country:US
Practice Address - Phone:912-583-4602
Practice Address - Fax:912-583-4085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare