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General NPI Number Information
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NPI Number | 1750306569
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Entity Type | Organization
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Legal Business Name | MAGNOLIA AMBULANCE SERVICE
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1129 BRETT DR SW SUITE A
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City | CONYERS
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State | GA
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Zip | 30094-5998
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Country | US
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Telephone | 770-761-7608
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Fax | 770-761-4078
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Provider Business Mailing Address
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Address Line | 1129 BRETT DR SW SUITE A
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City | CONYERS
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State | GA
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Zip | 30094-5998
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Country | US
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Telephone | 770-761-7608
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Fax | 770-761-4078
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Authorized Official
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Title or Position | DIRECTOR
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Name | CHRIS M HOFFER
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Credential |
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Telephone | 404-379-6261
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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 | 122-05
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License Number State | GA
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