Organization Active NPI

Evans County Board of Health

  • Public Health or Welfare Agency
  • Claxton, GA
National Provider Identifier
1922037209
Registry record updated Apr 27, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health or Welfare AgencyTaxonomy code 251K00000X
Legal business name
EVANS COUNTY BOARD OF HEALTH
Practice address
4 N Newton St
Claxton, GA 30417-1756
Phone
(912) 739-2088
Fax
(912) 739-3975
NPI assigned
Jun 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2011

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

Authorized official

Name
Starla Sutton
Title
Pso
Phone
(912) 427-2042

Specialties & licenses 1

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

Addresses

Primary practice location

4 N Newton St
Claxton, GA 30417-1756

Mailing address

PO Box 366
Claxton, GA 30417-0366
Phone (912) 739-2088

Other identifiers 4

IdentifierTypeStateIssuer
000442967LMedicaidGA
000052027KMedicaidGA
000777279AMedicaidGA
000457784LMedicaidGA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130529000698 GA Part B Supplier - Mass Immunization (Roster Biller Only) 2961496567 Practice locations: Claxton, GA

National Provider Directory

National Provider Directory

Locations

4 N Newton St
Claxton, GA 30417
Phone (912) 739-2088

Practitioners & affiliated clinicians

Practitioners 5

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": "1151625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303862400000",
    "number": "1922037209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 366",
            "city": "CLAXTON",
            "state": "GA",
            "postal_code": "304170366",
            "telephone_number": "912-739-2088",
            "fax_number": "912-739-3975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 N NEWTON ST",
            "city": "CLAXTON",
            "state": "GA",
            "postal_code": "304171756",
            "telephone_number": "912-739-2088",
            "fax_number": "912-739-3975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVANS COUNTY BOARD OF HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-30",
        "last_updated": "2011-04-27",
        "status": "A",
        "authorized_official_last_name": "SUTTON",
        "authorized_official_first_name": "STARLA",
        "authorized_official_title_or_position": "PSO",
        "authorized_official_telephone_number": "912-427-2042"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000442967L",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000052027K",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000777279A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000457784L",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Claxton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2011; 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.