Healthcare Provider Details

I. General information

NPI: 1427136498
Provider Name (Legal Business Name): CLAY COUNTY BOARD OF COMMISSIONERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 COMMERCE ST W
FORT GAINES GA
39851-3623
US

IV. Provider business mailing address

103 COMMERCE ST W
FORT GAINES GA
39851-3623
US

V. Phone/Fax

Practice location:
  • Phone: 229-768-3644
  • Fax:
Mailing address:
  • Phone: 229-768-3644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number030-02
License Number StateGA

VIII. Authorized Official

Name: TREY ANDERSON
Title or Position: CHAIRMAN OF THE BOC
Credential:
Phone: 229-768-3644