Healthcare Provider Details

I. General information

NPI: 1053252924
Provider Name (Legal Business Name): MONTECIA PAIGE EMT-I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 801519
ACWORTH GA
30101-1220
US

IV. Provider business mailing address

PO BOX 801519
ACWORTH GA
30101-1220
US

V. Phone/Fax

Practice location:
  • Phone: 770-731-3782
  • Fax:
Mailing address:
  • Phone: 770-731-3782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License NumberI039961
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: