Provider Demographics
NPI:1740271899
Name:COLQUITT COUNTY BOARD OF HEALTH
Entity type:Organization
Organization Name:COLQUITT COUNTY BOARD OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:RUIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-352-4275
Mailing Address - Street 1:214 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31776
Mailing Address - Country:US
Mailing Address - Phone:229-891-7100
Mailing Address - Fax:229-891-7106
Practice Address - Street 1:214 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31776
Practice Address - Country:US
Practice Address - Phone:229-891-7100
Practice Address - Fax:229-891-7106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00452933CMedicaid
GA00052049DMedicaid
GA00456475CMedicaid
GA000957767AMedicaid
GA00452933CMedicaid