MEDICARE: CLAY COUNTY BOARD OF COMMISSIONERS

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	3416L0300X	Land Ambulance	030-02	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	52256006-001	OTHER	GA	BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427136498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLAY COUNTY BOARD OF COMMISSIONERS

Provider Business Mailing Address
First Line	:	103 COMMERCE ST W
Second Line	:
City	:	FORT GAINES
State	:	GA
Zip	:	39851-3623
Country	:	US
Telephone Number	:	229-768-3644
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 COMMERCE ST W
Second Line	:
City	:	FORT GAINES
State	:	GA
Zip	:	39851-3623
Country	:	US
Telephone Number	:	229-768-3644
Fax Number	:

Authorized Official
Title or Position	:	CHAIRMAN OF THE BOC
Name	:	TREY ANDERSON
Credential	:
Telephone Number	:	229-768-3644

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	05/16/2013

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Directions to “CLAY COUNTY BOARD OF COMMISSIONERS ” Practice Location

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