Healthcare Provider Details

I. General information

NPI: 1790885010
Provider Name (Legal Business Name): CITY OF HAPEVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 04/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3468 N FULTON AVE
HAPEVILLE GA
30354-1466
US

IV. Provider business mailing address

PO BOX 82311
HAPEVILLE GA
30354-0311
US

V. Phone/Fax

Practice location:
  • Phone: 404-669-2141
  • Fax:
Mailing address:
  • Phone: 404-669-2141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number060-22
License Number StateGA

VIII. Authorized Official

Name: TOM MORRIS
Title or Position: CHIEF
Credential:
Phone: 404-669-2141