MEDICARE: PINNACLE AMBULANCE LLC

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	AMB2017024	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AMB2017024	OTHER	GA	LAND AMBULANCE LICENSE

General Provider Information

NPI Number	:	1578065595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINNACLE AMBULANCE LLC

Provider Business Mailing Address
First Line	:	312 CROSSTOWN DR STE 257
Second Line	:
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-2948
Country	:	US
Telephone Number	:	678-371-8818
Fax Number	:	678-364-7374

Provider Business Practice Location Address
First Line	:	2839 MOUNT ZION RD
Second Line	:
City	:	JONESBORO
State	:	GA
Zip	:	30236-6822
Country	:	US
Telephone Number	:	678-371-8818
Fax Number	:	678-364-7373

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. NABIH SABBAGH
Credential	:
Telephone Number	:	678-371-8818

Provider Enumeration Date	:	03/06/2018
Last Update Date	:	10/16/2019

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Directions to “PINNACLE AMBULANCE LLC ” Practice Location

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