Healthcare Provider Details

I. General information

NPI: 1093706913
Provider Name (Legal Business Name): LEE COUNTY BOARD OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 10/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 PARK ST
LEESBURG GA
31763
US

IV. Provider business mailing address

PO BOX 303
LEESBURG GA
31763-0303
US

V. Phone/Fax

Practice location:
  • Phone: 229-759-3014
  • Fax: 229-759-3017
Mailing address:
  • Phone: 229-759-3014
  • Fax: 229-759-3017

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: CHARLES D RUIS
Title or Position: DISTRICT HEALTH DIRECTOR
Credential: MD
Phone: 229-352-4275