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General NPI Number Information
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NPI Number | 1558111294
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Entity Type | Organization
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Legal Business Name | COMMUNITY CARE EMS LLC
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Dates
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Enumeration Date | 03/25/2024
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Last Update Date | 03/25/2024
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Provider Practice Location Address
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Address Line | 5877 COBALT DR
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City | POWDER SPRINGS
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State | GA
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Zip | 30127-4806
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Country | US
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Telephone | 770-873-2012
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Fax |
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Provider Business Mailing Address
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Address Line | 5877 COBALT DR
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City | POWDER SPRINGS
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State | GA
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Zip | 30127-4806
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Country | US
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Telephone | 770-873-2012
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RUSSELL JOHNSON
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Credential |
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Telephone | 770-873-2012
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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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