MEDICARE: DOOLY COUNTY COMMISSIONER OF ROADS AND REVENUES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance	046-01	GA
2	3416L0300X	Land Ambulance	046-01	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154401768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOOLY COUNTY COMMISSIONER OF ROADS AND REVENUES

Provider Business Mailing Address
First Line	:	209 W UNION ST
Second Line	:
City	:	VIENNA
State	:	GA
Zip	:	31092-1094
Country	:	US
Telephone Number	:	229-268-7529
Fax Number	:	229-268-3751

Provider Business Practice Location Address
First Line	:	209 W UNION ST
Second Line	:
City	:	VIENNA
State	:	GA
Zip	:	31092-1094
Country	:	US
Telephone Number	:	229-268-7529
Fax Number	:	229-268-3751

Authorized Official
Title or Position	:	EMS DIRECTOR
Name	:	MR. DON E. WILLFORD JR.
Credential	:
Telephone Number	:	229-268-7529

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	06/30/2015

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Directions to “DOOLY COUNTY COMMISSIONER OF ROADS AND REVENUES ” Practice Location

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