MEDICARE: DOOLY COUNTY SCHOOL SYSTEM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1396814034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOOLY COUNTY SCHOOL SYSTEM

Provider Business Mailing Address
First Line	:	146 ALLISON RD
Second Line	:
City	:	CORDELE
State	:	GA
Zip	:	31015-8022
Country	:	US
Telephone Number	:	229-273-3217
Fax Number	:	229-273-0704

Provider Business Practice Location Address
First Line	:	202 E COTTON ST
Second Line	:
City	:	VIENNA
State	:	GA
Zip	:	31092-1550
Country	:	US
Telephone Number	:	229-273-3217
Fax Number	:	229-273-0704

Authorized Official
Title or Position	:	BILLING AGENT
Name	:	MRS. MARGIE TISON
Credential	:
Telephone Number	:	229-273-3217

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	08/22/2020

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1982758223 — MARK M INGRAM DMD
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Directions to “DOOLY COUNTY SCHOOL SYSTEM ” Practice Location

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