Healthcare Provider Details

I. General information

NPI: 1326001108
Provider Name (Legal Business Name): PEACH COUNTY BOARD OF COMMISSIONERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W CHURCH ST
FORT VALLEY GA
31030-3732
US

IV. Provider business mailing address

205 W CHURCH ST
FORT VALLEY GA
31030-3732
US

V. Phone/Fax

Practice location:
  • Phone: 478-477-7131
  • Fax: 478-477-5636
Mailing address:
  • Phone: 478-477-7131
  • Fax: 478-477-5636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number111-04
License Number StateGA

VIII. Authorized Official

Name: ALFONZO C FORD
Title or Position: DIRECTOR
Credential:
Phone: 478-477-7131