Healthcare Provider Details

I. General information

NPI: 1588974521
Provider Name (Legal Business Name): PIONEER HEALTH SERVICES OF EARLY COUNTY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2010
Last Update Date: 10/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11740 COLUMBIA ST
BLAKELY GA
39823-2574
US

IV. Provider business mailing address

11740 COLUMBIA ST
BLAKELY GA
39823-2574
US

V. Phone/Fax

Practice location:
  • Phone: 229-723-4241
  • Fax:
Mailing address:
  • Phone: 229-723-4241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number049-04
License Number StateGA

VIII. Authorized Official

Name: JOSEPH S MCNULTY III
Title or Position: CEO
Credential:
Phone: 601-849-6440