MEDICARE: GLYNN COUNTY GEORGIA

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	063-01	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	590003739	OTHER	GA	MEDICARE RAILROAD

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	:	1851381156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLYNN COUNTY GEORGIA

Provider Business Mailing Address
First Line	:	PO BOX 429
Second Line	:
City	:	LEWISVILLE
State	:	NC
Zip	:	27023-0429
Country	:	US
Telephone Number	:	877-200-1191
Fax Number	:	336-740-9793

Provider Business Practice Location Address
First Line	:	121 PUBLIC SAFETY BLVD
Second Line	:
City	:	BRUNSWICK
State	:	GA
Zip	:	31525-8906
Country	:	US
Telephone Number	:	912-554-7779
Fax Number	:	912-297-3695

Authorized Official
Title or Position	:	ADMINISTRATIVE SUPERVISOR
Name	:	TERESA RENEE SHORB
Credential	:
Telephone Number	:	912-554-7779

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	08/15/2024

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Directions to “GLYNN COUNTY GEORGIA ” Practice Location

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