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General NPI Number Information
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NPI Number | 1124294434
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Entity Type | Organization
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Legal Business Name | TRI-COUNTY HEALTH SYSTEM, INC.
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Dates
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Enumeration Date | 05/06/2008
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 156 ALEXANDER STREET
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City | CRAWFORDVILLE
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State | GA
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Zip | 30631-2800
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Country | US
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Telephone | 706-456-2925
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Fax | 706-456-2224
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Provider Business Mailing Address
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Address Line | PO BOX 312
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City | WARRENTON
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State | GA
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Zip | 30828-0312
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Country | US
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Telephone | 706-465-3253
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Fax | 706-465-3028
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Authorized Official
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Title or Position | CEO
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Name | DONNA NEWSOME
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Credential |
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Telephone | 706-465-3253
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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