=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598107898
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | H&H III INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2013
-----------------------------------------------------
Last Update Date | 09/06/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 409 TOMMY LEE COOK RD
-----------------------------------------------------
City | PALMETTO
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30268-1545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-463-5712
-----------------------------------------------------
Fax | 770-463-5714
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 409 TOMMY LEE COOK RD
-----------------------------------------------------
City | PALMETTO
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30268-1545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-463-5712
-----------------------------------------------------
Fax | 770-463-5714
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MR. DALE LANCE HAYES
-----------------------------------------------------
Credential | EMT-I
-----------------------------------------------------
Telephone | 678-624-0635
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 38-05
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------