Provider Demographics
NPI:1831256783
Name:CLARKE COUNTY DEPARTMENT OF HEALTH
Entity type:Organization
Organization Name:CLARKE COUNTY DEPARTMENT OF HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOGGANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-583-2870
Mailing Address - Street 1:700 SUNSET DR STE 501
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2288
Mailing Address - Country:US
Mailing Address - Phone:706-425-2935
Mailing Address - Fax:706-425-2936
Practice Address - Street 1:700 SUNSET DR STE 501
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2288
Practice Address - Country:US
Practice Address - Phone:706-425-2935
Practice Address - Fax:706-425-2936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000456574MMedicaid
GA000456574NMedicaid
GA000456574MMedicaid
GA50BBGRGMedicare ID - Type Unspecified