Healthcare Provider Details

I. General information

NPI: 1992895122
Provider Name (Legal Business Name): BRYAN COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 LEDFORD STREET
PEMBROKE GA
31321-0009
US

IV. Provider business mailing address

150 SCRANTON CONNECTOR
BRUNSWICK GA
31525-0540
US

V. Phone/Fax

Practice location:
  • Phone: 912-653-4331
  • Fax: 912-653-4328
Mailing address:
  • Phone: 912-262-2347
  • Fax: 912-262-3036

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: MRS. STACY A COOPER
Title or Position: DISTRICT DEPT BILLING COORDINATOR
Credential:
Phone: 912-262-2347