Provider Demographics
NPI:1063859445
Name:SOUTHEAST AMBULANCE OF MIDDLE GEORGIA, INC.
Entity Type:Organization
Organization Name:SOUTHEAST AMBULANCE OF MIDDLE GEORGIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:PADGETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-202-4038
Mailing Address - Street 1:PO BOX 6241
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30604-6241
Mailing Address - Country:US
Mailing Address - Phone:706-202-4038
Mailing Address - Fax:
Practice Address - Street 1:855 SUNSET DR
Practice Address - Street 2:SUITE 19
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-7718
Practice Address - Country:US
Practice Address - Phone:706-202-4038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-26
Last Update Date:2013-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance