NPIMap

Organization Active NPI

Laurens County Board of Health

Doing business as Ryan White Clinic

  • Public Health or Welfare Agency
  • Dublin, GA
National Provider Identifier
1841505641
Registry record updated Nov 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health or Welfare AgencyTaxonomy code 251K00000X
Legal business name
LAURENS COUNTY BOARD OF HEALTH
Doing business as
Ryan White Clinic
Practice address
103 Mercer Dr Ste B
Dublin, GA 31021-4257
Phone
(478) 274-7949
Fax
(478) 274-7948
NPI assigned
Aug 17, 2010
Last updated
Nov 23, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
LAURENS COUNTY BOARD OF HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 23, 2022

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

Authorized official

Name
Michelle Mullis
Title
Administrator
Phone
(478) 275-6563

Specialties & licenses 1

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

Addresses

Primary practice location

103 Mercer Dr Ste B
Dublin, GA 31021-4257

Mailing address

105 E Jackson St
Dublin, GA 31021-6113
Phone (478) 275-6563

Other names 1

  • Ryan White Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131212001278 GA Part B Supplier - Clinic/Group Practice 9739356635 Receives reassigned benefits from 5 practitioners
Practice locations: Dublin, GA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Laurens Counth Health Dept5 organizations share this tax ID, including this one
Part of
Laurens Counth Health Dept

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

105 E Jackson St
Dublin, GA 31021

2121 Bellevue Rd
#B
Dublin, GA 31021

2121B Bellevue Rd
Dublin, GA 31021

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1282003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669161600000",
    "number": "1841505641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 E JACKSON ST",
            "city": "DUBLIN",
            "state": "GA",
            "postal_code": "310216113",
            "telephone_number": "478-275-6563",
            "fax_number": "478-275-6575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 MERCER DR STE B",
            "city": "DUBLIN",
            "state": "GA",
            "postal_code": "310214257",
            "telephone_number": "478-274-7949",
            "fax_number": "478-274-7948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAURENS COUNTY BOARD OF HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LAURENS COUNTY BOARD OF HEALTH",
        "enumeration_date": "2010-08-17",
        "last_updated": "2022-11-23",
        "certification_date": "2022-11-23",
        "status": "A",
        "authorized_official_last_name": "MULLIS",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "478-275-6563"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ryan White Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ryan White Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dublin, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2022; 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.