Provider Demographics
NPI:1992796965
Name:TERRELL COUNTY BOARD OF HEALTH
Entity type:Organization
Organization Name:TERRELL COUNTY BOARD OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:RUIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-352-4275
Mailing Address - Street 1:969 FORRESTER DR SE
Mailing Address - Street 2:
Mailing Address - City:DAWSON
Mailing Address - State:GA
Mailing Address - Zip Code:39842-2106
Mailing Address - Country:US
Mailing Address - Phone:229-995-2188
Mailing Address - Fax:229-995-2074
Practice Address - Street 1:969 FORRESTER DR SE
Practice Address - Street 2:
Practice Address - City:DAWSON
Practice Address - State:GA
Practice Address - Zip Code:39842-2106
Practice Address - Country:US
Practice Address - Phone:229-995-2188
Practice Address - Fax:229-995-2074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00456475LMedicaid
GA00560898BMedicaid
GA00452933LMedicaid
GA00052049MMedicaid
GA00456475LMedicaid