Healthcare Provider Details

I. General information

NPI: 1659435303
Provider Name (Legal Business Name): WILCOX COUNTY COMMISSIONER OF ROADS & REVENUES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 05/29/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 AMERICAN LEGION ROAD
ROCHELLE GA
31079
US

IV. Provider business mailing address

509 AMERICAN LEGION ROAD
ROCHELLE GA
31079
US

V. Phone/Fax

Practice location:
  • Phone: 229-949-3344
  • Fax: 229-365-7948
Mailing address:
  • Phone: 229-949-3344
  • Fax: 229-365-7948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number15602
License Number StateGA

VIII. Authorized Official

Name: CHARLES FUTCH
Title or Position: DIRECTOR
Credential:
Phone: 229-949-3344