Provider Demographics
NPI:1871991315
Name:GRAVES COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:GRAVES COUNTY HEALTH DEPARTMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SSSA III
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-247-3553
Mailing Address - Street 1:416 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-3115
Mailing Address - Country:US
Mailing Address - Phone:270-247-3553
Mailing Address - Fax:270-247-0391
Practice Address - Street 1:750 US HIGHWAY 60 W
Practice Address - Street 2:
Practice Address - City:SMITHLAND
Practice Address - State:KY
Practice Address - Zip Code:42081-8983
Practice Address - Country:US
Practice Address - Phone:270-247-3553
Practice Address - Fax:270-247-0391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare