Provider Demographics
NPI:1386798882
Name:SOUTHWEST GA HEALTH DISTRICT 8 UNIT 2 BCW
Entity type:Organization
Organization Name:SOUTHWEST GA HEALTH DISTRICT 8 UNIT 2 BCW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AND COLLECTIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRISH
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-758-3359
Mailing Address - Street 1:1306 S SLAPPEY BLVD STE J
Mailing Address - Street 2:SUITE J
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-2635
Mailing Address - Country:US
Mailing Address - Phone:229-430-2700
Mailing Address - Fax:229-420-1156
Practice Address - Street 1:1306 S SLAPPEY BLVD STE J
Practice Address - Street 2:SUITE J
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-2635
Practice Address - Country:US
Practice Address - Phone:229-430-2700
Practice Address - Fax:229-420-1156
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST GS HEALTH DISTRICT 8 UNIT 2
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-22
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0005482992AMedicaid