Provider Demographics
NPI:1427037522
Name:COUNTY OF BANKS
Entity Type:Organization
Organization Name:COUNTY OF BANKS
Other - Org Name:GOVT
Other - Org Type:Other Name
Authorized Official - Title/Position:EMERGENCY BILLING LLC
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:706-335-0123
Mailing Address - Street 1:150 HUDSON RDG STE 1
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:GA
Mailing Address - Zip Code:30547-3125
Mailing Address - Country:US
Mailing Address - Phone:706-335-0123
Mailing Address - Fax:706-335-0123
Practice Address - Street 1:150 HUDSON RDG STE 1
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:GA
Practice Address - Zip Code:30547-3125
Practice Address - Country:US
Practice Address - Phone:706-335-0123
Practice Address - Fax:706-335-0123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006-0013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000062697AMedicaid
GA000062697AMedicaid