Healthcare Provider Details

I. General information

NPI: 1831288679
Provider Name (Legal Business Name): POLK COUNTY BOARD OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 WATER ST
ROCKMART GA
30153-2669
US

IV. Provider business mailing address

320 WATER ST
ROCKMART GA
30153-2669
US

V. Phone/Fax

Practice location:
  • Phone: 770-684-1385
  • Fax: 770-684-8231
Mailing address:
  • Phone: 770-684-1385
  • Fax: 770-684-8231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number025271
License Number StateGA

VIII. Authorized Official

Name: C. WADE SELLERS
Title or Position: DISTRICT HEALTH DIRECTOR
Credential: M.D.
Phone: 706-295-6704