Provider Demographics
NPI:1770697724
Name:DOUGHERTY COUNTY BOARD OF HEALTH
Entity type:Organization
Organization Name:DOUGHERTY COUNTY BOARD OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-638-6424
Mailing Address - Street 1:PO BOX 3048
Mailing Address - Street 2:1710 S. SLAPPEY BLVD.
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31706-3048
Mailing Address - Country:US
Mailing Address - Phone:229-430-6225
Mailing Address - Fax:229-430-6350
Practice Address - Street 1:1710 S SLAPPEY BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-2634
Practice Address - Country:US
Practice Address - Phone:229-430-6225
Practice Address - Fax:229-430-6350
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOUGHERTY COUNTY HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-18
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE 0056383336C0003X, 251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1125613OtherNABP #
GAN27D2P0000Medicare UPIN