Provider Demographics
NPI:1275781197
Name:TATTNALL COUNTY COMMISSIONER OF ROADS AND REVENUES
Entity Type:Organization
Organization Name:TATTNALL COUNTY COMMISSIONER OF ROADS AND REVENUES
Other - Org Name:TATTNALL COMMUNITY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:MANN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:912-557-6757
Mailing Address - Street 1:194 JOHN O PARKER RD
Mailing Address - Street 2:P.O. BOX 1006
Mailing Address - City:REIDSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30453-1006
Mailing Address - Country:US
Mailing Address - Phone:912-557-3640
Mailing Address - Fax:912-557-1846
Practice Address - Street 1:194 JOHN O PARKER ROAD
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30453-1006
Practice Address - Country:US
Practice Address - Phone:912-557-3640
Practice Address - Fax:912-557-1846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA132-033416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport