Healthcare Provider Details

I. General information

NPI: 1225091028
Provider Name (Legal Business Name): STEPHENS COUNTY BOARD OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 12/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 BOULEVARD STE 102
TOCCOA GA
30577-3010
US

IV. Provider business mailing address

64 BOULEVARD STE 102
TOCCOA GA
30577-3010
US

V. Phone/Fax

Practice location:
  • Phone: 706-282-4507
  • Fax: 706-282-4511
Mailing address:
  • Phone: 706-282-4507
  • Fax: 706-282-4511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00051972K
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer
# 2
Identifier000924679C
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer
# 3
Identifier00453109K
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer
# 4
Identifier00649437G
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer
# 5
Identifier00058638A
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer
# 6
Identifier00442945L
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer
# 7
Identifier00456442D
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer

VIII. Authorized Official

Name: DR. DAVID N WESTFALL
Title or Position: HEALTH DIRECTOR
Credential: M.D.
Phone: 770-535-5743