Organization Active NPI

Early County Health Dept

  • Public Health or Welfare Agency
  • Blakely, GA
National Provider Identifier
1447241591
Registry record updated Jan 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health or Welfare AgencyTaxonomy code 251K00000X
Legal business name
EARLY COUNTY HEALTH DEPT
Practice address
618 Flowers Dr
Blakely, GA 39823-2804
Phone
(229) 723-3707
Fax
(229) 723-8246
NPI assigned
Oct 28, 2005
Last updated
Jan 25, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2024

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

Authorized official

Name
Treisha Johnson
Title
District Admin
Phone
(229) 248-3055

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X NU Primary

Addresses

Primary practice location

618 Flowers Dr
Blakely, GA 39823-2804

Mailing address

618 Flowers Dr
Blakely, GA 39823-2804
Phone (229) 723-3707

Other identifiers 4

IdentifierTypeStateIssuer
00442879EMedicaidGA
00052049GMedicaidGA
00442879GMedicaidGA
00456475FMedicaidGA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150424000052 GA Part B Supplier - Mass Immunization (Roster Biller Only) 9032011572 Practice locations: Blakely, GA

National Provider Directory

National Provider Directory

Locations

618 Flowers Dr
Blakely, GA 39823
Phone (229) 207-0049

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1130457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706140800000",
    "number": "1447241591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "618 FLOWERS DR",
            "city": "BLAKELY",
            "state": "GA",
            "postal_code": "398232804",
            "telephone_number": "229-723-3707",
            "fax_number": "229-723-8246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "618 FLOWERS DR",
            "city": "BLAKELY",
            "state": "GA",
            "postal_code": "398232804",
            "telephone_number": "229-723-3707",
            "fax_number": "229-723-8246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EARLY COUNTY HEALTH DEPT",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-28",
        "last_updated": "2024-01-25",
        "certification_date": "2024-01-25",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "TREISHA",
        "authorized_official_title_or_position": "DISTRICT ADMIN",
        "authorized_official_telephone_number": "229-248-3055"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00442879E",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00052049G",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00442879G",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00456475F",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Blakely, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 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.