MEDICARE: TATTNALL COUNTY COMMISSIONER OF ROADS & REVENUES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	132-03	GA
2	3416L0300X	Land Ambulance

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033256060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TATTNALL COUNTY COMMISSIONER OF ROADS & REVENUES

Provider Business Mailing Address
First Line	:	PO BOX 1006
Second Line	:
City	:	REIDSVILLE
State	:	GA
Zip	:	30453-1006
Country	:	US
Telephone Number	:	912-557-1911
Fax Number	:	912-557-6088

Provider Business Practice Location Address
First Line	:	194 JOHN O PARKER DRIVE
Second Line	:
City	:	REIDSVILLE
State	:	GA
Zip	:	30453-0000
Country	:	US
Telephone Number	:	912-557-3640
Fax Number	:	912-557-3840

Authorized Official
Title or Position	:	PUBLIC SAFETY DIRECT
Name	:	MR. WILLIAM R KIRKLAND JR.
Credential	:
Telephone Number	:	912-557-1911

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	06/03/2013

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Directions to “TATTNALL COUNTY COMMISSIONER OF ROADS & REVENUES ” Practice Location

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