=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770675787
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY EMS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2006
-----------------------------------------------------
Last Update Date | 07/18/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 EAGLES WALK STE 200
-----------------------------------------------------
City | STOCKBRIDGE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30281-7281
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-389-5329
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 EAGLES WALK SUITE 200
-----------------------------------------------------
City | STOCKBRIDGE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30281-7204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-389-5329
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EMS DIRECTOR
-----------------------------------------------------
Name | LITA KING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 770-389-5329
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 075-05
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------