Provider Demographics
NPI:1477542983
Name:ELBERT COUNTY GEORGIA
Entity Type:Organization
Organization Name:ELBERT COUNTY GEORGIA
Other - Org Name:ELBERT COUNTY GEORGIA
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF EMS/911
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:N
Authorized Official - Last Name:ALMOND
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:706-283-2003
Mailing Address - Street 1:PO BOX 6010
Mailing Address - Street 2:112 MAHONEY DR
Mailing Address - City:ELBERTON
Mailing Address - State:GA
Mailing Address - Zip Code:30635-6010
Mailing Address - Country:US
Mailing Address - Phone:706-283-2003
Mailing Address - Fax:706-283-2024
Practice Address - Street 1:112 MAHONEY DR
Practice Address - Street 2:
Practice Address - City:ELBERTON
Practice Address - State:GA
Practice Address - Zip Code:30635-6010
Practice Address - Country:US
Practice Address - Phone:706-283-2003
Practice Address - Fax:706-283-2024
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELBERT COUNTY GEORGIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-18
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052-013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000472029AMedicaid
GA000472029AMedicaid