Healthcare Provider Details

I. General information

NPI: 1861485765
Provider Name (Legal Business Name): BUTTS COUNTY BOARD OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

463 ERNEST BILES DR SUITE A
JACKSON GA
30233-2229
US

IV. Provider business mailing address

463 ERNEST BILES DR SUITE A
JACKSON GA
30233-2229
US

V. Phone/Fax

Practice location:
  • Phone: 770-504-2230
  • Fax: 770-504-2229
Mailing address:
  • Phone: 770-504-2133
  • Fax: 770-504-2229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RHONDA ELLINGTON
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 706-298-7732