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General NPI Number Information
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NPI Number | 1811370174
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Entity Type | Organization
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Legal Business Name | MEMBERS EMS
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Dates
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Enumeration Date | 07/06/2015
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Last Update Date | 09/19/2016
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Provider Practice Location Address
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Address Line | 5499 JONESBORO RD
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City | LAKE CITY
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State | GA
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Zip | 30260-3553
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Country | US
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Telephone | 404-901-2272
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Fax |
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Provider Business Mailing Address
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Address Line | 5499 JONESBORO RD
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City | LAKE CITY
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State | GA
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Zip | 30260-3553
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Country | US
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Telephone | 404-901-2272
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TIMOTHY HAYWOOD MCKNIGHT
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Credential |
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Telephone | 404-901-2272
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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 | AMB2016013
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License Number State | GA
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