MEDICARE: BOARD OF HEALTH WALTON COUNTY

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	261QP0905X	State or Local Public Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619014529
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOARD OF HEALTH WALTON COUNTY

Provider Business Mailing Address
First Line	:	1404 S MADISON AVE
Second Line	:
City	:	MONROE
State	:	GA
Zip	:	30655-2816
Country	:	US
Telephone Number	:	770-207-4125
Fax Number	:	770-207-4129

Provider Business Practice Location Address
First Line	:	1404 S MADISON AVE
Second Line	:
City	:	MONROE
State	:	GA
Zip	:	30655-2816
Country	:	US
Telephone Number	:	770-207-4125
Fax Number	:	770-207-4129

Authorized Official
Title or Position	:	HEALTH DIRECTOR
Name	:	DONALD S GOGGANS
Credential	:	MD
Telephone Number	:	706-583-2870

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	07/23/2025

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Directions to “BOARD OF HEALTH WALTON COUNTY ” Practice Location

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