NPIMap

Organization Active NPI

Peach County Board of Health

  • State or Local Public Health Clinic/Center
  • Fort Valley, GA
National Provider Identifier
1366450934
Registry record updated Jul 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
State or Local Public Health Clinic/CenterTaxonomy code 261QP0905X
Legal business name
PEACH COUNTY BOARD OF HEALTH
Practice address
503 Bluebird Blvd
Fort Valley, GA 31030-5096
Phone
(478) 825-6939
Fax
(478) 825-6792
NPI assigned
Aug 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Danielle McNair
Title
Authorized Official
Phone
(478) 751-6303

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X
State or Local Public Health Clinic/Center 261QP0905X Primary

Addresses

Primary practice location

503 Bluebird Blvd
Fort Valley, GA 31030-5096

Mailing address

201 2ND St Ste 1100
Macon, GA 31201-6328
Phone (478) 297-5190

Other identifiers 4

IdentifierTypeStateIssuer
003185983AMedicaidGA
003186608AMedicaidGA
00051961KMedicaidGA
000733224AMedicaidGA

Other names 1

  • Peach County Health Department Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090724000505 GA Part B Supplier - Mass Immunization (Roster Biller Only) 8729131651 Practice locations: Fort Valley, GA

National Provider Directory

National Provider Directory

Locations

406 E Church St
Fort Valley, GA 31030
Phone (478) 825-6939

900 Campus Dr
Fort Valley, GA 31030

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721692800000",
    "number": "1366450934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 2ND ST STE 1100",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312016328",
            "telephone_number": "478-297-5190",
            "fax_number": "478-751-6099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 BLUEBIRD BLVD",
            "city": "FORT VALLEY",
            "state": "GA",
            "postal_code": "310305096",
            "telephone_number": "478-825-6939",
            "fax_number": "478-825-6792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACH COUNTY BOARD OF HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-03",
        "last_updated": "2024-07-23",
        "certification_date": "2024-07-23",
        "status": "A",
        "authorized_official_last_name": "MCNAIR",
        "authorized_official_first_name": "DANIELLE",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "478-751-6303"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP0905X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Public Health, State or Local",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003185983A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003186608A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00051961K",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000733224A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peach County Health Department",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Peach County Health Department",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fort Valley, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.