Provider Demographics
NPI:1467531939
Name:JOHNSON COUNTY COMMISSIONER OF ROADS AND REVENUES
Entity Type:Organization
Organization Name:JOHNSON COUNTY COMMISSIONER OF ROADS AND REVENUES
Other - Org Name:JOHNSON COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRANTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:EMT I
Authorized Official - Phone:478-240-2199
Mailing Address - Street 1:PO BOX 269
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31096-0269
Mailing Address - Country:US
Mailing Address - Phone:478-240-2199
Mailing Address - Fax:478-240-2298
Practice Address - Street 1:7055 GA HWY 15
Practice Address - Street 2:
Practice Address - City:WRIGHTSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31096-0269
Practice Address - Country:US
Practice Address - Phone:478-240-2199
Practice Address - Fax:478-240-2298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA083-023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA85043059AAMedicare ID - Type UnspecifiedMEDICARE NUMBER