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General NPI Number Information
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NPI Number | 1093921629
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Entity Type | Organization
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Legal Business Name | LANIER COUNTY AMBULANCE SERVICE
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 05/17/2011
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Provider Practice Location Address
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Address Line | 116 W THIGPEN AVE
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City | LAKELAND
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State | GA
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Zip | 31635-1006
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Country | US
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Telephone | 229-482-8401
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Fax | 229-482-8539
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Provider Business Mailing Address
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Address Line | PO BOX 5888 ATTN: PFS DEPT.
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City | VALDOSTA
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State | GA
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Zip | 31603-5888
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Country | US
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Telephone | 229-482-8402
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Fax | 229-482-8539
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. NEIL GINTY
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Credential | RN
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Telephone | 229-482-8402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 08601
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License Number State | GA
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