Provider Demographics
NPI:1134291842
Name:BOARD OF COUNTY COMMISSIONERS
Entity Type:Organization
Organization Name:BOARD OF COUNTY COMMISSIONERS
Other - Org Name:JEFF DAVIS COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-699-9012
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:GA
Mailing Address - Zip Code:31539-0609
Mailing Address - Country:US
Mailing Address - Phone:912-699-9012
Mailing Address - Fax:912-699-9049
Practice Address - Street 1:3 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:GA
Practice Address - Zip Code:31539-6219
Practice Address - Country:US
Practice Address - Phone:912-699-9012
Practice Address - Fax:912-699-9049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA080-013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000002747AMedicaid