Healthcare Provider Details

I. General information

NPI: 1336286053
Provider Name (Legal Business Name): COUNTY OF DAVIDSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date: 03/07/2008
Reactivation Date: 12/24/2008

III. Provider practice location address

915 N GREENSBORO ST.
LEXINGTON NC
27292-2699
US

IV. Provider business mailing address

PO BOX 439
LEXINGTON NC
27293-0439
US

V. Phone/Fax

Practice location:
  • Phone: 336-242-2300
  • Fax: 336-242-2485
Mailing address:
  • Phone: 336-242-2300
  • Fax: 336-242-2485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. LILLIAN KOONTZ
Title or Position: HEALTH DIRECTOR
Credential: M.P.A, R.E.H.S
Phone: 336-242-2349