Provider Demographics
NPI:1043275134
Name:CLAY COUNTY BOARD OF HEALTH
Entity type:Organization
Organization Name:CLAY COUNTY BOARD OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT HEALTH DIRECTORY
Authorized Official - Prefix:
Authorized Official - First Name:ZSOLT
Authorized Official - Middle Name:
Authorized Official - Last Name:KOPPANYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-321-6300
Mailing Address - Street 1:2100 COMER AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-8725
Mailing Address - Country:US
Mailing Address - Phone:706-321-6300
Mailing Address - Fax:
Practice Address - Street 1:147 WILSON STREET
Practice Address - Street 2:
Practice Address - City:FT. GAINES
Practice Address - State:GA
Practice Address - Zip Code:39851
Practice Address - Country:US
Practice Address - Phone:229-768-2355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000676552AMedicaid
GA000798091AMedicaid
GA00052082CMedicaid
GA00457729GMedicaid
GA00457729GMedicaid