Provider Demographics
NPI:1770574584
Name:THOMAS COUNTY BOARD OF HEALTH
Entity type:Organization
Organization Name:THOMAS 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:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31799-0148
Mailing Address - Country:US
Mailing Address - Phone:229-226-4241
Mailing Address - Fax:229-379-3520
Practice Address - Street 1:484 SMITH AVE
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-5535
Practice Address - Country:US
Practice Address - Phone:229-226-4241
Practice Address - Fax:229-226-5144
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST GEORGIA HEALTH DISTRICT 8-2
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-01
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00052049NMedicaid
GA00442879DMedicaid
GA000452933MMedicaid
GA860975978AMedicaid
GA00456475MMedicaid
GA00456475MMedicaid