Healthcare Provider Details

I. General information

NPI: 1689603979
Provider Name (Legal Business Name): PIERCE COUNTY BOARD OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 WARE ST
BLACKSHEAR GA
31516-1723
US

IV. Provider business mailing address

715 WARE ST
BLACKSHEAR GA
31516-1723
US

V. Phone/Fax

Practice location:
  • Phone: 912-449-2032
  • Fax: 912-449-0409
Mailing address:
  • Phone: 912-449-2032
  • Fax: 912-449-0409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: STARLA SUTTON
Title or Position: PSO
Credential:
Phone: 912-427-2042