Provider Demographics
NPI:1912365263
Name:FULTON COUNTY GOVERNMENT
Entity Type:Organization
Organization Name:FULTON COUNTY GOVERNMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLICE HEALTH NURSE
Authorized Official - Prefix:
Authorized Official - First Name:MARVA
Authorized Official - Middle Name:MELISSA
Authorized Official - Last Name:MONROE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:404-612-5835
Mailing Address - Street 1:265 BOULEVARD NE FL 3
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:265 BOULEVARD NE FL 3
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1208
Practice Address - Country:US
Practice Address - Phone:404-612-5835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QF00X261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)