Provider Demographics
NPI:1093789075
Name:WHITFIELD COUNTY BOARD OF HEALTH
Entity type:Organization
Organization Name:WHITFIELD COUNTY BOARD OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:KINSEY
Authorized Official - Suffix:
Authorized Official - Credentials:CPB
Authorized Official - Phone:706-529-5757
Mailing Address - Street 1:800 PROFESSIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2536
Mailing Address - Country:US
Mailing Address - Phone:706-279-9600
Mailing Address - Fax:706-281-2325
Practice Address - Street 1:800 PROFESSIONAL BLVD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2536
Practice Address - Country:US
Practice Address - Phone:706-279-9600
Practice Address - Fax:706-281-2325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251K00000X, 261QR1300X
GA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251B00000XAgenciesCase Management
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000188493AMedicaid
GA000480609BMedicaid
GA000051994GMedicaid
GA000456519GMedicaid
GA000058671AMedicaid
GA000456519HMedicaid
GA000480609AMedicaid
GA113808Medicare Oscar/Certification
GAGRP4194Medicare PIN