Provider Demographics
NPI:1174568372
Name:APPLING COUNTY BOARD OF HEALTH
Entity type:Organization
Organization Name:APPLING COUNTY BOARD OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSO
Authorized Official - Prefix:MRS
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 37
Mailing Address - Street 2:
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31515-0037
Mailing Address - Country:US
Mailing Address - Phone:912-367-4601
Mailing Address - Fax:912-367-1096
Practice Address - Street 1:34 WALNUT ST
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-0119
Practice Address - Country:US
Practice Address - Phone:912-367-4601
Practice Address - Fax:912-367-1096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000442967BMedicaid
GA000611619AMedicaid
GA000453098AMedicaid
GA000052027BMedicaid
GA000457784AMedicaid
GA000453098AMedicaid
GAFLU118Medicare ID - Type UnspecifiedCOUNTY FLU BILLING #
GA000611619AMedicaid