Healthcare Provider Details

I. General information

NPI: 1104835164
Provider Name (Legal Business Name): MADISON CO COMMISSIONER ROADS AND REVENUE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 98 W
DANIELSVILLE GA
30633
US

IV. Provider business mailing address

91 ALBANY AVE
DANIELSVILLE GA
30633
US

V. Phone/Fax

Practice location:
  • Phone: 706-795-6300
  • Fax: 706-795-2980
Mailing address:
  • Phone: 706-795-6300
  • Fax: 706-795-2980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number09501
License Number StateGA

VIII. Authorized Official

Name: CHERRI MAE WYATT
Title or Position: BILLING SPECIALIST
Credential:
Phone: 706-795-6307