Healthcare Provider Details

I. General information

NPI: 1649485046
Provider Name (Legal Business Name): CRITICAL CARE MEDFLIGHT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 BRISCOE BLVD
LAWRENCEVILLE GA
30045-4637
US

IV. Provider business mailing address

530 BRISCOE BLVD
LAWRENCEVILLE GA
30045-4637
US

V. Phone/Fax

Practice location:
  • Phone: 770-513-9148
  • Fax: 770-513-0249
Mailing address:
  • Phone: 770-513-9148
  • Fax: 770-513-0249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JEFF GUSTAFSON
Title or Position: MEDFLIGHT DIRECTOR
Credential:
Phone: 770-513-9148