=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649152497
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BOARD OF HEALTH WALTON COUNTY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2025
-----------------------------------------------------
Last Update Date | 07/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4385 PECAN ST
-----------------------------------------------------
City | LOGANVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30052-2637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-466-1789
-----------------------------------------------------
Fax | 770-466-1321
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1404 S MADISON AVE
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30655-2816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-207-4125
-----------------------------------------------------
Fax | 770-207-4129
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HEALTH DIRECTOR
-----------------------------------------------------
Name | DONALD S GOGGANS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 706-583-2870
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP0905X
-----------------------------------------------------
Taxonomy Name | State or Local Public Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------