1689739765 NPI number — TERRELL COUNTY COMMISSIONER OF ROADS & REVENUES

Table of content: (NPI 1689739765)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689739765 NPI number — TERRELL COUNTY COMMISSIONER OF ROADS & REVENUES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TERRELL COUNTY COMMISSIONER OF ROADS & REVENUES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TERRELL COUNTY EMS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689739765
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
638 FORRESTER DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAWSON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
39842-2009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-995-4008
Provider Business Mailing Address Fax Number:
229-995-4869

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
638 FORRESTER DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAWSON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
39842-2009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-995-4008
Provider Business Practice Location Address Fax Number:
229-995-4869
Provider Enumeration Date:
12/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RAKEL
Authorized Official First Name:
GAIL
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
229-995-4008

Provider Taxonomy Codes

  • Taxonomy code: 146L00000X , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 341600000X , with the licence number: 135-01 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000003055A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".