Healthcare Provider Details

I. General information

NPI: 1396814034
Provider Name (Legal Business Name): DOOLY COUNTY SCHOOL SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 E COTTON ST
VIENNA GA
31092-1550
US

IV. Provider business mailing address

146 ALLISON RD
CORDELE GA
31015-8022
US

V. Phone/Fax

Practice location:
  • Phone: 229-273-3217
  • Fax: 229-273-0704
Mailing address:
  • Phone: 229-273-3217
  • Fax: 229-273-0704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARGIE TISON
Title or Position: BILLING AGENT
Credential:
Phone: 229-273-3217