Provider Demographics
NPI:1538198882
Name:ATKINSON COUNTY BOARD OF HEALTH
Entity type:Organization
Organization Name:ATKINSON COUNTY BOARD OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSO
Authorized Official - Prefix:
Authorized Official - First Name:STARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-427-2042
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:PEARSON
Mailing Address - State:GA
Mailing Address - Zip Code:31642-0218
Mailing Address - Country:US
Mailing Address - Phone:912-422-3332
Mailing Address - Fax:912-422-7345
Practice Address - Street 1:636 AUSTIN AVE E
Practice Address - Street 2:
Practice Address - City:PEARSON
Practice Address - State:GA
Practice Address - Zip Code:31642-8257
Practice Address - Country:US
Practice Address - Phone:912-422-3332
Practice Address - Fax:912-422-7345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000052027CMedicaid
GA000724655AMedicaid
GA000453098BMedicaid
GA000457784BMedicaid
GA000442967CMedicaid
GA600002576Medicare ID - Type UnspecifiedRAILROAD BILLING #
GAGRP3493Medicare ID - Type UnspecifiedCOUNTY MDCR BILLING#
GA000453098BMedicaid