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General NPI Number Information
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NPI Number | 1881906063
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Entity Type | Organization
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Legal Business Name | TRI STAR AMBULANCE LLC
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Dates
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Enumeration Date | 07/05/2010
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Last Update Date | 07/05/2010
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Provider Practice Location Address
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Address Line | 5900 MAXHAM RD SUITE 13
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City | AUSTELL
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State | GA
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Zip | 30168-4258
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Country | US
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Telephone | 404-966-5553
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Fax | 770-745-6491
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Provider Business Mailing Address
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Address Line | 5900 MAXHAM RD SUITE 13
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City | AUSTELL
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State | GA
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Zip | 30168-4258
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Country | US
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Telephone | 404-966-5553
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Fax | 770-745-6491
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Authorized Official
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Title or Position | CEO
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Name | MR. NAIEF ABUKHALID
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Credential |
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Telephone | 404-966-5553
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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 | 033-49
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License Number State | GA
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