Provider Demographics
NPI:1700442753
Name:REGION XI FIELD FISCAL OFFICE
Entity Type:Organization
Organization Name:REGION XI FIELD FISCAL OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-389-4691
Mailing Address - Street 1:PO BOX 690
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31534-0690
Mailing Address - Country:US
Mailing Address - Phone:912-389-4691
Mailing Address - Fax:912-389-4996
Practice Address - Street 1:1400 PETERSON AVE N STE D
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2833
Practice Address - Country:US
Practice Address - Phone:912-389-4691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare