Healthcare Provider Details

I. General information

NPI: 1255859179
Provider Name (Legal Business Name): NORTH STAR MEDICAL TRANSPORT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2017
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

556 GINN STREET
CARNESVILLE GA
30521-9997
US

IV. Provider business mailing address

556 GINN STREET
CARNESVILLE GA
30521-9997
US

V. Phone/Fax

Practice location:
  • Phone: 706-452-1695
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: AIMEE KENERLY
Title or Position: AO
Credential:
Phone: 706-452-1695