Provider Demographics
NPI:1902890205
Name:COUNTY OF LAURENS BOARD OF COMMISSIONERS
Entity type:Organization
Organization Name:COUNTY OF LAURENS BOARD OF COMMISSIONERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-272-0199
Mailing Address - Street 1:PO BOX 1523
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31040-1523
Mailing Address - Country:US
Mailing Address - Phone:478-272-0124
Mailing Address - Fax:478-277-2929
Practice Address - Street 1:646 COUNTY FARM RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-1799
Practice Address - Country:US
Practice Address - Phone:478-272-0124
Practice Address - Fax:478-277-2929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA087-033416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000189406AMedicaid
GA=========OtherTAX ID NUMBER
GA000189406AMedicaid