MEDICARE: CITY OF FOREST PARK

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	03105	GA

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	:	1255315800
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF FOREST PARK

Provider Business Mailing Address
First Line	:	4539 JONESBORO RD
Second Line	:
City	:	FOREST PARK
State	:	GA
Zip	:	30297-3542
Country	:	US
Telephone Number	:	404-608-2373
Fax Number	:	404-608-2385

Provider Business Practice Location Address
First Line	:	4539 JONESBORO RD
Second Line	:
City	:	FOREST PARK
State	:	GA
Zip	:	30297-3542
Country	:	US
Telephone Number	:	404-608-2383
Fax Number	:	404-608-2385

Authorized Official
Title or Position	:	INTERIM EMS DIRECTOR
Name	:	ALFRED SMITH
Credential	:
Telephone Number	:	470-947-2194

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	06/26/2025

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Directions to “CITY OF FOREST PARK ” Practice Location

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