Decatur County Board of Health
Organization Active NPI Public Health or Welfare Agency · Bainbridge, GA
NPI 1720079874 · NPPES record last updated Oct 23, 2017
Key facts
- NPI
- 1720079874
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Public Health or Welfare Agency 251K00000X
- Legal business name
- DECATUR COUNTY BOARD OF HEALTH
- Practice address
- 928 S West St
Bainbridge, GA 39819-4581 - Phone
- (229) 248-3055
- Fax
- (229) 248-2648
- NPI assigned
- Oct 28, 2005
- Organization subpart
- No
Authorized official
- Name
- Charles D Ruis, MD
- Title
- District Health Director
- Phone
- (229) 352-4275
Practitioners 2
-
Jacqueline H Grant, MD, MPH, MPA
-
Charles D Ruis, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20111107000314 | GA | Part B Supplier - Public Health/Welfare Agency | 5294908398 | Practice locations: Bainbridge, GA |
National Provider Directory
Locations
928 S West St
Bainbridge, GA 39819
Phone (229) 248-3055
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Public Health or Welfare Agency | 251K00000X | Yes |
Addresses
Primary practice location
928 S West St
Bainbridge, GA 39819-4581
Mailing address
928 S West St
Bainbridge, GA 39819-4581
Phone (229) 248-3055
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00442879B | Medicaid | GA | |
| 00052049E | Medicaid | GA | |
| 00452933D | Medicaid | GA | |
| 00456475D | Medicaid | GA |
Other providers in Bainbridge, GA
- Christy Curry
- Breanna Lynn Darley
- Darrell W. Carpenter, MD PC
- Decatur County Board of Commissioners
- Decatur County Board of Education
- Decatur County School System
- Decatur Emergency Physicians LLC
- Decatur Opco LLC
- Leslie Ann Dellenbarger
- Deseree Broddie
All providers in Bainbridge, 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 Oct 23, 2017. 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.