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General NPI Number Information
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NPI Number | 1598064289
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Entity Type | Organization
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Legal Business Name | MARINE CORPS LOGISTICS BASE ALBANY, GA
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Dates
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Enumeration Date | 03/21/2011
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Last Update Date | 06/02/2014
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Provider Practice Location Address
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Address Line | 814 RADFORD BLVD SUITE 20346
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City | ALBANY
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State | GA
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Zip | 31704-1130
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Country | US
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Telephone | 229-639-5610
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Fax |
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Provider Business Mailing Address
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Address Line | 814 RADFORD BLVD SUITE 20346
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City | ALBANY
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State | GA
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Zip | 31704-1130
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Country | US
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Telephone | 229-639-5610
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Fax |
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Authorized Official
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Title or Position | ASST. FIRE CHIEF OF OPERATIONS
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Name | FOREST M THOMAS
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Credential |
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Telephone | 229-639-5610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 993
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License Number State | GA
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