Provider Demographics
NPI:1417257890
Name:PREMIER EMS ATLANTA
Entity Type:Organization
Organization Name:PREMIER EMS ATLANTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LUA
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:DUONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-353-8098
Mailing Address - Street 1:268 JONESBORO RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-2402
Mailing Address - Country:US
Mailing Address - Phone:770-389-9110
Mailing Address - Fax:678-593-5631
Practice Address - Street 1:268 JONESBORO RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2402
Practice Address - Country:US
Practice Address - Phone:770-389-9110
Practice Address - Fax:678-593-5631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA075-09341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance