Provider Demographics
NPI:1558091967
Name:DEPLOYED TACTICS
Entity Type:Organization
Organization Name:DEPLOYED TACTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ASHTON
Authorized Official - Middle Name:BLAIR
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:202-655-8161
Mailing Address - Street 1:40 JUDY CT # B
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-3876
Mailing Address - Country:US
Mailing Address - Phone:202-655-8161
Mailing Address - Fax:
Practice Address - Street 1:40 JUDY CT PH A
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-3876
Practice Address - Country:US
Practice Address - Phone:202-655-8161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA057070191OtherDL