NORTHEAST HEALTH DISTRICT - EPSDT (NPI# 1477758332) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477758332 |
| Entity Type | Organization |
| Organization Name | NORTHEAST HEALTH DISTRICT - EPSDT |
| Other Organization Name | OCONEE CO HLTH DEPT DIST 10 |
| Practice Address |
1060 Experiment Station Rd Watkinsville GA 30677-5323 |
| Mailing Address |
Po Box 222 Watkinsville GA 30677-0006 |
| Practice Telephone | 7067693983 |
| Practice Fax Number | 7067693913 |
| Mailing Telephone | 7067693983 |
| Mailing Fax Number | 7067693913 |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2017-04-06 |
| Authorized Official Name | DR. CLAUDE A BURNETT III (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 7065832870 |
| Authorized Official Credential | M.D., M.P.H. |
| Is Organization Subpart | Y |
| Parent Organization Name | NORTHEAST HEALTH DISTRICT - EPSDT |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP0905X |
Clinic/Center Specialization: Public Health, State or Local |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 000051983I | 05 |
| Other Name | Type Code |
|---|---|
| OCONEE CO HLTH DEPT DIST 10 | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205031267 | Northeast Health District - Epsdt | Clinic/Center | 2005 S Main St Ste 200, Madison, GA 30650-2055 | 2007-06-19 |
| Street Address |
1060 EXPERIMENT STATION RD |
| City | WATKINSVILLE |
| State | GA |
| Zip Code | 30677-5323 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861539835 | Oconee County Health Department | Clinic/Center | 1060 Experiment Station Rd, Watkinsville, GA 30677-5323 | 2007-01-31 |
| 1740713205 | Oconee County Health Department | Clinic/Center | 1060 Experiment Station Rd, Watkinsville, GA 30677-5323 | 2017-04-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669071478 | Brenda Gerai James | Behavior Technician | 1272 Virgil Langford Rd, Ste 101, Watkinsville, GA 30677 | 2020-10-22 |
| 1881292597 | Chloe Wise | Specialist/Technologist | 360 Caduceus Way Building 600 - Suite 101., Watkinsville, GA 30677 | 2020-10-14 |
| 1912518531 | Samuel S Kwon - Athens Dmd PC | Dentist | 1795 Resurgence Drive, Suite 101, Watkinsville, GA 30677 | 2020-08-17 |
| 1972131977 | Hopebridge LLC | Behavioral Analyst | 1272 Virgil Langford Road, Suite 101, Watkinsville, GA 30677 | 2020-03-27 |
| 1306479068 | Meggan Brittany Reed | Counselor | 1550 Jennings Mill Rd, Suite 1700b, Watkinsville, GA 30677 | 2020-02-20 |
| 1699322040 | Christopher's Bridge, LLC | In Home Supportive Care | 3651 Mars Hill Rd, Suite 1600, Watkinsville, GA 30677 | 2019-08-21 |
| 1093209538 | Haley Bauguss | Physician Assistant | 1624 Mars Hill Road, Suite B, Watkinsville, GA 30677 | 2018-06-19 |
| 1134618317 | Amanda Burns Denson | Nurse Practitioner | 1181 Langford Drive, Building 300, Suite 104, Watkinsville, GA 30677 | 2018-05-03 |
| 1780105528 | Inspiring Hospice Partners of Georgia LLC | Hospice Care, Community Based | 1252 Virgil Langford Rd, Watkinsville, GA 30677 | 2017-07-01 |
| 1750753182 | Zachary Russell | Orthopaedic Surgery | 1305 Jennings Mill Road, Building 300, Suite 110, Watkinsville, GA 30677 | 2015-10-26 |
| Find all providers in zip 30677 | ||||
| Taxonomy Code | 261QP0905X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Public Health, State or Local |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861539835 | Oconee County Health Department | Clinic/Center | 1060 Experiment Station Rd, Watkinsville, GA 30677-5323 | 2007-01-31 |
| 1740713205 | Oconee County Health Department | Clinic/Center | 1060 Experiment Station Rd, Watkinsville, GA 30677-5323 | 2017-04-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972628089 | Northeast Health District - Epsdt County | Clinic/Center | 623 S Elm St, Commerce, GA 30529-3208 | 2007-03-20 |
| 1942324181 | Board of Health Walton County | Clinic/Center | 4385 Pecan St, Loganville, GA 30052-2637 | 2007-03-16 |
| 1831223015 | Clarke County Department of Health | Clinic/Center | 410 Mckinley Dr, Athens, GA 30601-3270 | 2007-03-16 |
| 1396879821 | Clarke County Department of Health | Clinic/Center | 168 Rocksprings Ct, Athens, GA 30606-6372 | 2007-03-15 |
| 1174668255 | Northeast Health District | Clinic/Center | 740 Prince Ave Bldg 15, Athens, GA 30606 | 2007-02-20 |
| 1679614515 | Georgia Department of Human Resources | Clinic/Center | 1309 Redmond Rd Nw, Rome, GA 30165-1307 | 2007-02-12 |
| 1851432173 | Floyd County Health Department | Clinic/Center | 16 East 12th Street, Suite 202, Rome, GA 30161-4720 | 2007-02-09 |
| 1174660187 | Madison County Health Department | Clinic/Center | 1424 Highway 98 W, Danielsville, GA 30633-5356 | 2007-01-31 |
| 1649317686 | Jackson County Health Department | Clinic/Center | 341 Stan Evans Dr, Jefferson, GA 30549-2909 | 2007-01-31 |
| 1063559086 | Greene County Health Department | Clinic/Center | 1031 Apalachee Ave, Greensboro, GA 30642-2710 | 2007-01-31 |
| Find all providers with the same taxonomy | ||||
| City | WATKINSVILLE |
| Zip Code | 30677 |
Please comment or provide details below to improve the information on NORTHEAST HEALTH DISTRICT - EPSDT.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.