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General NPI Number Information
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NPI Number | 1275823122
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Entity Type | Organization
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Legal Business Name | EXCELSIOR AMBULANCE SERVICE INC
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Dates
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Enumeration Date | 04/12/2011
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 1 EXCELSIOR WAY SE
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City | LUDOWICI
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State | GA
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Zip | 31316-0979
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Country | US
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Telephone | 912-278-1725
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Fax | 912-454-5100
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Provider Business Mailing Address
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Address Line | 1 EXCELSIOR WAY SE
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City | LUDOWICI
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State | GA
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Zip | 31316-0979
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Country | US
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Telephone | 912-278-1725
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Fax | 912-454-5100
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES A GRAHAM
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Credential | MD
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Telephone | 912-278-1725
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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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Taxonomy #2
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 001-03
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License Number State | GA
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