MEDICARE: DOOLY COUNTY BOARD OF HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336184076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOOLY COUNTY BOARD OF HEALTH

Provider Business Mailing Address
First Line	:	2100 COMER AVE
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-8725
Country	:	US
Telephone Number	:	706-321-6300
Fax Number	:

Provider Business Practice Location Address
First Line	:	204 W UNION ST
Second Line	:
City	:	VIENNA
State	:	GA
Zip	:	31092-1056
Country	:	US
Telephone Number	:	229-268-4725
Fax Number	:	229-268-1567

Authorized Official
Title or Position	:	HEALTH DIRECTOR
Name	:	ZSOLT KOPPANYI
Credential	:	M.D.
Telephone Number	:	706-321-6300

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	11/14/2007

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Directions to “DOOLY COUNTY BOARD OF HEALTH ” Practice Location

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