Provider Demographics
NPI:1770528804
Name:TATTNALL COUNTY BOARD OF HEALTH
Entity type:Organization
Organization Name:TATTNALL COUNTY BOARD OF HEALTH
Other - Org Name:<UNAVAIL>
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:PO BOX 353
Mailing Address - Street 2:
Mailing Address - City:GLENNVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30427-0353
Mailing Address - Country:US
Mailing Address - Phone:912-654-5290
Mailing Address - Fax:912-654-5296
Practice Address - Street 1:1000 N VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:GLENNVILLE
Practice Address - State:GA
Practice Address - Zip Code:30427-8603
Practice Address - Country:US
Practice Address - Phone:912-654-5290
Practice Address - Fax:912-654-5293
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TATTNALL COUNTY BOARD OF HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-20
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000457784OMedicaid
GA000052027XMedicaid
GA000770648BMedicaid
GA000453098PMedicaid
GA000442967QMedicaid
GA000453098PMedicaid
GA000442967QMedicaid
GA000052027XMedicaid