Provider Demographics
NPI:1396705935
Name:MANCHESTER HEALTH DEPARTMENT
Entity type:Organization
Organization Name:MANCHESTER HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-298-7732
Mailing Address - Street 1:300 W PERRY ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:GA
Mailing Address - Zip Code:31816-1346
Mailing Address - Country:US
Mailing Address - Phone:706-672-4974
Mailing Address - Fax:066-721-0657
Practice Address - Street 1:300 W PERRY ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:GA
Practice Address - Zip Code:31816-1346
Practice Address - Country:US
Practice Address - Phone:706-846-3353
Practice Address - Fax:706-846-2674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAREF000026462251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00519054AMedicaid
GA00663495AMedicaid
GA00456453JMedicaid
GA00784363AMedicaid
GA00456453ACMedicaid
GA750490044AMedicaid