Provider Demographics
NPI:1386824589
Name:DODGE COUNTY COMMISSIONER OF ROADS AND REVENUES
Entity Type:Organization
Organization Name:DODGE COUNTY COMMISSIONER OF ROADS AND REVENUES
Other - Org Name:DODGE COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COUNTY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-374-4361
Mailing Address - Street 1:PO BOX 818
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-0818
Mailing Address - Country:US
Mailing Address - Phone:478-374-4361
Mailing Address - Fax:478-374-8121
Practice Address - Street 1:901 GRIFFIN AVE
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-6720
Practice Address - Country:US
Practice Address - Phone:478-374-4361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045-023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport