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General NPI Number Information
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NPI Number | 1942962048
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Entity Type | Organization
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Legal Business Name | LIFE STAT EMS
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Dates
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Enumeration Date | 10/06/2021
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Last Update Date | 01/20/2022
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Provider Practice Location Address
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Address Line | 3551 BALL GROUND HWY
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City | CANTON
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State | GA
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Zip | 30114-7411
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Country | US
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Telephone | 404-987-6278
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Fax | 678-807-2631
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Provider Business Mailing Address
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Address Line | PO BOX 4636
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City | CANTON
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State | GA
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Zip | 30114-0019
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Country | US
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Telephone | 404-987-6278
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Fax | 678-807-2631
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MICHAEL L WATERS
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Credential |
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Telephone | 770-490-3911
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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 |
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License Number State |
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