Chattahoochee Board of Health
Organization Active NPI Public Health or Welfare Agency · Cusseta, GA
NPI 1700840501 · NPPES record last updated Jan 28, 2010
Key facts
- NPI
- 1700840501
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Public Health or Welfare Agency 251K00000X
- Legal business name
- CHATTAHOOCHEE BOARD OF HEALTH
- Practice address
- 213 McNaughton St
Cusseta, GA 31805-3013 - Phone
- (706) 989-3663
- Fax
- (706) 989-1243
- NPI assigned
- Apr 17, 2006
- Organization subpart
- No
Authorized official
- Name
- Zsolt Koppanyi, M.D.
- Title
- Health Director
- Phone
- (706) 321-6300
Practitioners 1
-
Pamela J Harlan, RNC WHNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040220000594 | GA | Part B Supplier - Public Health/Welfare Agency | 1850286550 | Practice locations: Cusseta, GA |
| O20150401001011 | GA | Part B Supplier - Mass Immunization (Roster Biller Only) | 1850286550 | Practice locations: Cusseta, GA |
National Provider Directory
Locations
213 McNaughton St
Cusseta, GA 31805
Phone (706) 989-3663
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Public Health or Welfare Agency | 251K00000X | Yes |
Addresses
Primary practice location
213 McNaughton St
Cusseta, GA 31805-3013
Mailing address
2100 Comer Ave
Columbus, GA 31904-8725
Phone (706) 321-6300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000453164R | Medicaid | GA | |
| 319144 | Other | GA | WELLCARE OF GA |
| 00647149A | Medicaid | GA | |
| 000457729J | Medicaid | GA | |
| 00052082B | Medicaid | GA |
Other providers in Cusseta, GA
- Audra Michelle Allen
- Mia Beveridge
- Jessica Roberson Brown
- Careconnect Health, Inc.
- Chattahoochee County School System
- Cusseta Rehab Solutions, LLC
- Pamela J Harlan
- James Anthony Roberts
- Angela Sims
All providers in Cusseta, GA · Public Health or Welfare Agency in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 28, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.