MEDICARE: BUTTS 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	163W00000X	Registered Nurse
2	261QP0905X	State or Local Public Health Clinic/Center

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

General Provider Information

NPI Number	:	1861485765
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUTTS COUNTY BOARD OF HEALTH

Provider Business Mailing Address
First Line	:	463 ERNEST BILES DR
Second Line	:	SUITE A
City	:	JACKSON
State	:	GA
Zip	:	30233-2229
Country	:	US
Telephone Number	:	770-504-2133
Fax Number	:	770-504-2229

Provider Business Practice Location Address
First Line	:	463 ERNEST BILES DR
Second Line	:	SUITE A
City	:	JACKSON
State	:	GA
Zip	:	30233-2229
Country	:	US
Telephone Number	:	770-504-2230
Fax Number	:	770-504-2229

Authorized Official
Title or Position	:	BILLING SUPERVISOR
Name	:	RHONDA ELLINGTON
Credential	:
Telephone Number	:	706-298-7732

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	09/06/2023

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Directions to “BUTTS COUNTY BOARD OF HEALTH ” Practice Location

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