=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568411619
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GARRETT COUNTY HEALTH DEPARTMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2006
-----------------------------------------------------
Last Update Date | 09/18/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1025 MEMORIAL DR
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21550-4343
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-334-7706
-----------------------------------------------------
Fax | 301-334-7701
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1025 MEMORIAL DR
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21550-4343
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-334-7706
-----------------------------------------------------
Fax | 301-334-7701
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FISCAL ACCOUNTS TECHNICIAN II
-----------------------------------------------------
Name | MRS. CAROL MARTIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 301-334-7665
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------