Healthcare Provider Details

I. General information

NPI: 1174523989
Provider Name (Legal Business Name): GEORGIA AEROEMDICAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 AIRPORT RD NW HANGER E
KENNESAW GA
30144-7031
US

IV. Provider business mailing address

PO BOX 2257
KENNESAW GA
30156-9103
US

V. Phone/Fax

Practice location:
  • Phone: 770-368-1070
  • Fax: 770-368-1080
Mailing address:
  • Phone: 770-368-1070
  • Fax: 770-368-1080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MS. STACY KATHERINE NORRIS
Title or Position: MANAGER
Credential:
Phone: 770-368-1070