Healthcare Provider Details

I. General information

NPI: 1700840501
Provider Name (Legal Business Name): CHATTAHOOCHEE BOARD OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 01/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 MCNAUGHTON ST
CUSSETA GA
31805-3013
US

IV. Provider business mailing address

2100 COMER AVE
COLUMBUS GA
31904-8725
US

V. Phone/Fax

Practice location:
  • Phone: 706-989-3663
  • Fax: 706-989-1243
Mailing address:
  • Phone: 706-321-6300
  • Fax: 706-321-6126

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: ZSOLT KOPPANYI
Title or Position: HEALTH DIRECTOR
Credential: M.D.
Phone: 706-321-6300