Provider Demographics
NPI:1326408071
Name:ADVANCE 1 AMBULANCE LLC
Entity Type:Organization
Organization Name:ADVANCE 1 AMBULANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:OSAMA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HAMDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-771-1595
Mailing Address - Street 1:1415 HIGHWAY 85 N
Mailing Address - Street 2:310-310
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7738
Mailing Address - Country:US
Mailing Address - Phone:770-771-1595
Mailing Address - Fax:
Practice Address - Street 1:315 INDUSTRIAL WAY
Practice Address - Street 2:A
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-8265
Practice Address - Country:US
Practice Address - Phone:770-771-1595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAMB2016003341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance