Healthcare Provider Details

I. General information

NPI: 1942324181
Provider Name (Legal Business Name): BOARD OF HEALTH WALTON COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4385 PECAN ST
LOGANVILLE GA
30052-2637
US

IV. Provider business mailing address

4385 PECAN ST
LOGANVILLE GA
30052-2637
US

V. Phone/Fax

Practice location:
  • Phone: 770-466-1789
  • Fax: 770-466-1321
Mailing address:
  • Phone: 770-466-1789
  • Fax: 770-466-1321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DONALD S GOGGANS
Title or Position: HEALTH DIRECTOR
Credential: MD
Phone: 706-583-2870