Provider Demographics
NPI:1104911924
Name:CLAYTON COUNTY HEALTH DISTRICT
Entity type:Organization
Organization Name:CLAYTON COUNTY HEALTH DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LACRECIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WORTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-610-7199
Mailing Address - Street 1:1117 BATTLECREEK RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-2407
Mailing Address - Country:US
Mailing Address - Phone:678-610-7199
Mailing Address - Fax:770-603-4872
Practice Address - Street 1:1117 BATTLECREEK RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2407
Practice Address - Country:US
Practice Address - Phone:678-610-7199
Practice Address - Fax:770-603-4872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000051928AMedicaid
GA000058528AMedicaid
GA000442934AMedicaid
GA000456409BMedicaid