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General NPI Number Information
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NPI Number | 1144667098
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Entity Type | Organization
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Legal Business Name | DELTA AMBULANCE LLC
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Dates
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Enumeration Date | 06/03/2013
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Last Update Date | 06/03/2013
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Provider Practice Location Address
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Address Line | 2341 CENTENNIAL DR STE B
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City | GAINESVILLE
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State | GA
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Zip | 30504-5762
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Country | US
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Telephone | 770-880-3033
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Fax | 770-297-8600
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Provider Business Mailing Address
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Address Line | 2341 CENTENNIAL DR STE B
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City | GAINESVILLE
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State | GA
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Zip | 30504-5762
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Country | US
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Telephone | 770-880-3033
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Fax | 770-297-8600
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Authorized Official
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Title or Position | OWNER
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Name | MR. HAZEM ALTAMIMI
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Credential |
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Telephone | 770-880-3033
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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 | 069-27
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License Number State | GA
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