Provider Demographics
NPI:1346355864
Name:MID GEORGIA AMBULANCE
Entity Type:Organization
Organization Name:MID GEORGIA AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAE
Authorized Official - Middle Name:
Authorized Official - Last Name:HINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-741-8804
Mailing Address - Street 1:2025 VINEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-3142
Mailing Address - Country:US
Mailing Address - Phone:478-741-8804
Mailing Address - Fax:478-742-0358
Practice Address - Street 1:2025 VINEVILLE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-3142
Practice Address - Country:US
Practice Address - Phone:478-741-8804
Practice Address - Fax:478-742-0358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011-02341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00133757AMedicaid
GA85039759AAMedicare ID - Type Unspecified