Provider Demographics
NPI:1548747173
Name:GA PEACH MEDICAL TRANSPORTATION, LLC
Entity Type:Organization
Organization Name:GA PEACH MEDICAL TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:TYRONE
Authorized Official - Last Name:MIDDLEBROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-705-8076
Mailing Address - Street 1:5023 GA HIGHWAY 85
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-2431
Mailing Address - Country:US
Mailing Address - Phone:678-705-8076
Mailing Address - Fax:678-705-8079
Practice Address - Street 1:5023 HIGHWAY 85
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297
Practice Address - Country:US
Practice Address - Phone:678-705-8076
Practice Address - Fax:678-705-8079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport