Healthcare Provider Details

I. General information

NPI: 1285081562
Provider Name (Legal Business Name): APPALACHIAN DISTRICT HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 NORTHWEST LN
WARRENSVILLE NC
28693-9244
US

IV. Provider business mailing address

PO BOX 208
JEFFERSON NC
28640-0208
US

V. Phone/Fax

Practice location:
  • Phone: 336-384-1625
  • Fax:
Mailing address:
  • Phone: 336-246-9449
  • Fax: 336-982-3555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE DOUGHERTY
Title or Position: CREDENTIALER/BILLING COORDINATOR
Credential:
Phone: 336-246-9449