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General NPI Number Information
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NPI Number | 1417240490
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Entity Type | Organization
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Legal Business Name | GEORGIA DEPARTMENT OF PUBLIC HEALTH
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Dates
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Enumeration Date | 05/24/2011
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Last Update Date | 05/24/2011
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Provider Practice Location Address
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Address Line | 1749 CLAIRMONT RD
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City | DECATUR
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State | GA
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Zip | 30033-4005
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Country | US
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Telephone | 404-327-7900
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Fax | 404-327-7919
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Provider Business Mailing Address
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Address Line | 2 PEACHTREE STREET NW 15TH FLOOR
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City | ATLANTA
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State | GA
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Zip | 30303-3142
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Country | US
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Telephone | 404-657-2700
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Fax | 404-657-2715
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Authorized Official
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Title or Position | COMMISSIONER
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Name | DR. BRENDA R. FITZGERALD
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Credential | M.D.
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Telephone | 404-657-2700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 044-121
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License Number State | GA
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