Provider Demographics
NPI:1316142169
Name:CLARKE COUNTY BOARD-HEALTH
Entity type:Organization
Organization Name:CLARKE COUNTY BOARD-HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DISTRICT HEALTH DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAUDE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:III
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:706-583-2870
Mailing Address - Street 1:220 RESEARCH DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-2738
Mailing Address - Country:US
Mailing Address - Phone:706-583-2856
Mailing Address - Fax:706-369-5732
Practice Address - Street 1:220 RESEARCH DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-2738
Practice Address - Country:US
Practice Address - Phone:706-583-2856
Practice Address - Fax:706-369-5732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000457927AMedicaid