Healthcare Provider Details

I. General information

NPI: 1467531939
Provider Name (Legal Business Name): JOHNSON COUNTY COMMISSIONER OF ROADS AND REVENUES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7055 GA HWY 15
WRIGHTSVILLE GA
31096-0269
US

IV. Provider business mailing address

PO BOX 269
WRIGHTSVILLE GA
31096-0269
US

V. Phone/Fax

Practice location:
  • Phone: 478-240-2199
  • Fax: 478-240-2298
Mailing address:
  • Phone: 478-240-2199
  • Fax: 478-240-2298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number083-02
License Number StateGA

VIII. Authorized Official

Name: JULIE D BRANTLEY
Title or Position: OFFICE MANAGER
Credential: EMT I
Phone: 478-240-2199