Provider Demographics
NPI:1841856242
Name:DFCS REGION IX
Entity type:Organization
Organization Name:DFCS REGION IX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL OPERATION GENERALIST
Authorized Official - Prefix:
Authorized Official - First Name:TANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-296-6155
Mailing Address - Street 1:PO BOX 948
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31040-0948
Mailing Address - Country:US
Mailing Address - Phone:478-275-6533
Mailing Address - Fax:478-296-6154
Practice Address - Street 1:904 CLAXTON DAIRY RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-5423
Practice Address - Country:US
Practice Address - Phone:478-275-6533
Practice Address - Fax:478-296-6154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000043887AMedicaid