Provider Demographics
NPI:1770765828
Name:LAURENS COUNTY BOARD OF HEALTH
Entity type:Organization
Organization Name:LAURENS COUNTY BOARD OF HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:WILKES
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-275-6545
Mailing Address - Street 1:1623 RICE AVE
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-3522
Mailing Address - Country:US
Mailing Address - Phone:478-275-6841
Mailing Address - Fax:478-274-7893
Practice Address - Street 1:1623 RICE AVE
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-3522
Practice Address - Country:US
Practice Address - Phone:478-275-6841
Practice Address - Fax:478-274-7893
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAURENS COUNTY BOARD OF HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency