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General NPI Number Information
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NPI Number | 1780063552
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Entity Type | Organization
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Legal Business Name | REDMOND PARK
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Dates
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Enumeration Date | 05/26/2015
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Last Update Date | 05/26/2015
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Provider Practice Location Address
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Address Line | 501 REDMOND RD NW
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City | ROME
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State | GA
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Zip | 30165-1415
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Country | US
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Telephone | 706-802-3297
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Fax | 706-802-3887
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Provider Business Mailing Address
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Address Line | 501 REDMOND RD NW
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City | ROME
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State | GA
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Zip | 30165-1415
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Country | US
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Telephone | 706-802-3297
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Fax | 706-802-3887
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Authorized Official
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Title or Position | MANAGER OF FINANCIAL MANAGEMENT
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Name | MRS. BECKY S MAYTON
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Credential |
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Telephone | 706-802-3297
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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 | 1356552350
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License Number State | GA
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