Provider Demographics
NPI:1336395615
Name:LAURENS COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:LAURENS COUNTY BOARD OF HEALTH
Other - Org Name:LAURENS COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:WILKES
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-275-6545
Mailing Address - Street 1:2121B BELLEVUE RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2952
Mailing Address - Country:US
Mailing Address - Phone:478-275-6545
Mailing Address - Fax:478-275-6567
Practice Address - Street 1:702 ACADEMY AVE STE A
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-4083
Practice Address - Country:US
Practice Address - Phone:478-296-2040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000297932FMedicaid