Provider Demographics
NPI:1669565172
Name:HART COUNTY BOARD OF HEALTH
Entity type:Organization
Organization Name:HART COUNTY BOARD OF HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-376-5117
Mailing Address - Street 1:64 REYNOLDS STREET
Mailing Address - Street 2:
Mailing Address - City:HARTWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30643
Mailing Address - Country:US
Mailing Address - Phone:706-376-5117
Mailing Address - Fax:
Practice Address - Street 1:64 REYNOLDS STREET
Practice Address - Street 2:
Practice Address - City:HARTWELL
Practice Address - State:GA
Practice Address - Zip Code:30643
Practice Address - Country:US
Practice Address - Phone:706-376-5117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000442945IMedicaid
GA00058638AMedicaid
GA000285535EMedicaid
GA00649437DMedicaid
GA00051972HMedicaid
GA00456442GMedicaid