=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528360930
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MED1 SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2010
-----------------------------------------------------
Last Update Date | 11/18/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2030 POWERS FERRY RD SE SUITE 120
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-801-2325
-----------------------------------------------------
Fax | 770-690-2617
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2030 POWERS FERRY RD SE SUITE 120
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-801-2325
-----------------------------------------------------
Fax | 770-690-2617
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | MR. JOHN TYLER TAYLOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 678-801-2325
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------