Provider Demographics
NPI:1124112339
Name:BANKS COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:BANKS COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:N
Authorized Official - Last Name:WESTFALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-677-2296
Mailing Address - Street 1:667 THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:GA
Mailing Address - Zip Code:30547-3110
Mailing Address - Country:US
Mailing Address - Phone:706-677-2296
Mailing Address - Fax:706-677-4042
Practice Address - Street 1:667 THOMPSON STREET
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:GA
Practice Address - Zip Code:30547
Practice Address - Country:US
Practice Address - Phone:706-677-2296
Practice Address - Fax:706-677-4042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA015524251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10044114OtherAMERIGROUP PROVIDER NUMBE
GA9179947OtherDORAL PROVIDER NUMBER
GA00051972BMedicaid
GA00479751EMedicaid
GA00442945BMedicaid
GA39253OtherAVESIS PROVIDER NUMBER
GA00058638AMedicaid
GA00456442NMedicaid
GA338783OtherWELLCARE PROVIDER NUMBER