Provider Demographics
NPI:1326001108
Name:PEACH COUNTY BOARD OF COMMISSIONERS
Entity Type:Organization
Organization Name:PEACH COUNTY BOARD OF COMMISSIONERS
Other - Org Name:PEACH COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALFONZO
Authorized Official - Middle Name:C
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-477-7131
Mailing Address - Street 1:205 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:FORT VALLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31030-3732
Mailing Address - Country:US
Mailing Address - Phone:478-477-7131
Mailing Address - Fax:478-477-5636
Practice Address - Street 1:205 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:FORT VALLEY
Practice Address - State:GA
Practice Address - Zip Code:31030-3732
Practice Address - Country:US
Practice Address - Phone:478-477-7131
Practice Address - Fax:478-477-5636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA111-043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00065513AMedicaid
GA00065513AMedicaid