Provider Demographics
NPI:1326036161
Name:WEST GEORGIA AMBULANCE INC
Entity Type:Organization
Organization Name:WEST GEORGIA AMBULANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:S
Authorized Official - Last Name:CREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-812-9745
Mailing Address - Street 1:PO BOX 624
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30112-0012
Mailing Address - Country:US
Mailing Address - Phone:770-832-9689
Mailing Address - Fax:770-836-0151
Practice Address - Street 1:1952 N HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-8340
Practice Address - Country:US
Practice Address - Phone:770-832-9689
Practice Address - Fax:770-836-0151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022-07341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00848141AMedicaid
GA59RCBKGMedicare UPIN