MEDICARE: GRADY 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	065-01	GA

General Provider Information

NPI Number	:	1881861300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRADY COUNTY BOARD OF COMMISSIONERS

Provider Business Mailing Address
First Line	:	1651 N BROAD ST
Second Line	:
City	:	CAIRO
State	:	GA
Zip	:	39828-1160
Country	:	US
Telephone Number	:	229-377-6413
Fax Number	:	229-377-3940

Provider Business Practice Location Address
First Line	:	1651 N BROAD ST
Second Line	:
City	:	CAIRO
State	:	GA
Zip	:	39828-1160
Country	:	US
Telephone Number	:	229-377-6413
Fax Number	:	229-377-3940

Authorized Official
Title or Position	:	DIRECTOR
Name	:	RODNEY GORDON
Credential	:
Telephone Number	:	229-377-6413

Provider Enumeration Date	:	05/14/2008
Last Update Date	:	12/03/2025

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