Healthcare Provider Details

I. General information

NPI: 1477542983
Provider Name (Legal Business Name): ELBERT COUNTY GEORGIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 08/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 MAHONEY DR
ELBERTON GA
30635-6010
US

IV. Provider business mailing address

PO BOX 6010 112 MAHONEY DR
ELBERTON GA
30635-6010
US

V. Phone/Fax

Practice location:
  • Phone: 706-283-2003
  • Fax: 706-283-2024
Mailing address:
  • Phone: 706-283-2003
  • Fax: 706-283-2024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number052-01
License Number StateGA

VIII. Authorized Official

Name: CHARLES N ALMOND JR.
Title or Position: DIRECTOR OF EMS/911
Credential:
Phone: 706-283-2003