Healthcare Provider Details

I. General information

NPI: 1770697724
Provider Name (Legal Business Name): DOUGHERTY COUNTY BOARD OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 10/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 S SLAPPEY BLVD
ALBANY GA
31701-2634
US

IV. Provider business mailing address

PO BOX 3048 1710 S. SLAPPEY BLVD.
ALBANY GA
31706-3048
US

V. Phone/Fax

Practice location:
  • Phone: 229-430-6225
  • Fax: 229-430-6350
Mailing address:
  • Phone: 229-430-6225
  • Fax: 229-430-6350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE 005638
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License NumberPHRE 005638
License Number StateGA

VIII. Authorized Official

Name: DONNA COOK
Title or Position: DISTRICT PHARMACIST
Credential:
Phone: 229-638-6424