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General NPI Number Information
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NPI Number | 1205112752
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Entity Type | Organization
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Legal Business Name | LIFECARE EMS OF GEORGIA, LLC
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Dates
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Enumeration Date | 10/28/2011
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Last Update Date | 04/22/2024
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Provider Practice Location Address
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Address Line | 363 BALDWIN RD
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City | CORNELIA
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State | GA
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Zip | 30531-5785
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Country | US
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Telephone | 706-754-0295
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Fax | 706-245-6187
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Provider Business Mailing Address
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Address Line | PO BOX 5860
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City | ATHENS
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State | GA
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Zip | 30604-5860
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Country | US
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Telephone | 706-245-0689
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Fax | 706-245-6187
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Authorized Official
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Title or Position | OWNER
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Name | BRIAN HANEY
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Credential |
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Telephone | 706-245-0689
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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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