Organization
BRYAN COUNTY HEALTH DEPARTMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STACY A COOPER (DISTRICT DEPT BILLING COORDINATOR)
(912) 262-2347
Entity
Organization
Contact information
Practice address
430 LEDFORD STREET, PEMBROKE, GA 31321-0009
(912) 653-4331
(912) 653-4328
Mailing address
150 SCRANTON CONNECTOR, BRUNSWICK, GA 31525-0540
(912) 262-2347
(912) 262-3036
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000051818B
—
GA
05
—
000453219E
—
GA
05
—
000456508A
—
GA
05
—
000457938B
—
GA
05
—
000551922A
—
GA
01
—
FLU139
MEDICARE NUMBER
GA
Enumeration date
10/16/2006
Last updated
01/06/2015
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