Provider Demographics
NPI:1811926116
Name:TATTNALL COUNTY BOARD OF HEALTH
Entity type:Organization
Organization Name:TATTNALL COUNTY BOARD OF HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSO
Authorized Official - Prefix:
Authorized Official - First Name:STARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-427-2042
Mailing Address - Street 1:PO BOX 426
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30453-0426
Mailing Address - Country:US
Mailing Address - Phone:912-557-7850
Mailing Address - Fax:912-557-7854
Practice Address - Street 1:200-B SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30453-4602
Practice Address - Country:US
Practice Address - Phone:912-557-7850
Practice Address - Fax:912-557-7854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000777048AMedicaid
GA000052027NMedicaid
GA000453098OMedicaid
GA000442967RMedicaid
GA000457784PMedicaid
GAGRP4467Medicare ID - Type UnspecifiedCOUNTY MDCR BILLING #
GA000777048AMedicaid
GA000442967RMedicaid