Healthcare Provider Details

I. General information

NPI: 1699842856
Provider Name (Legal Business Name): BLECKLEY COUNTY BOARD OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 05/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 NORTH EIGHTH STREET
COCHRAN GA
31014
US

IV. Provider business mailing address

152 NORTH EIGHTH STREET
COCHRAN GA
31014
US

V. Phone/Fax

Practice location:
  • Phone: 478-934-6590
  • Fax: 478-934-8729
Mailing address:
  • Phone: 478-934-6590
  • Fax: 478-934-8729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CANDACE SPICER CHRISTIAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 478-275-6545