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General NPI Number Information
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NPI Number | 1124651724
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Entity Type | Organization
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Legal Business Name | GRACE EMS, LLC
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Dates
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Enumeration Date | 02/21/2020
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Last Update Date | 02/21/2020
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Provider Practice Location Address
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Address Line | 91 DAVID BURNETTE DR
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City | BLAIRSVILLE
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State | GA
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Zip | 30512-5102
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Country | US
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Telephone | 877-472-2311
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Fax | 877-472-2339
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Provider Business Mailing Address
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Address Line | PO BOX 2331
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City | BLAIRSVILLE
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State | GA
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Zip | 30514-2331
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Country | US
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Telephone | 877-472-2311
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Fax | 877-472-2339
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Authorized Official
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Title or Position | OWNER
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Name | MARC ERWIN BURNETTE
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Credential |
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Telephone | 877-472-2311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State |
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