Healthcare Provider Details

I. General information

NPI: 1902191935
Provider Name (Legal Business Name): FAITH MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2011
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 J2 INTERSTATE RIDGE DRIVE
GAINESVILLE GA
30501
US

IV. Provider business mailing address

955 J2 INTERSTATE RIDGE DRIVE
GAINESVILLE GA
30501
US

V. Phone/Fax

Practice location:
  • Phone: 770-533-2673
  • Fax: 770-534-6843
Mailing address:
  • Phone: 770-533-2673
  • Fax: 770-534-6843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number069-022
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateGA

VIII. Authorized Official

Name: MRS. JULIE ANN MARTIN
Title or Position: OWNER
Credential:
Phone: 77053332673