Provider Demographics
NPI:1336177914
Name:CLINCH COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:CLINCH COUNTY BOARD OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSO
Authorized Official - Prefix:
Authorized Official - First Name:STARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-427-2042
Mailing Address - Street 1:285 SWEAT ST
Mailing Address - Street 2:
Mailing Address - City:HOMERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31634-2301
Mailing Address - Country:US
Mailing Address - Phone:912-487-2199
Mailing Address - Fax:912-487-3407
Practice Address - Street 1:285 SWEAT ST
Practice Address - Street 2:
Practice Address - City:HOMERVILLE
Practice Address - State:GA
Practice Address - Zip Code:31634-2301
Practice Address - Country:US
Practice Address - Phone:912-487-2199
Practice Address - Fax:912-487-3407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000442967IMedicaid
GA000052027IMedicaid
GA000453098IMedicaid
GA000457784IMedicaid
GA000777576AMedicaid
GA000453098IMedicaid
GA600000733Medicare ID - Type UnspecifiedRAILROAD BILLING #
GAFLU126Medicare ID - Type UnspecifiedCOUNTY FLU BILLING #