Provider Demographics
NPI:1588664452
Name:TELFAIR COUNTY COMMISSIONER OF ROADS & REVENUES
Entity Type:Organization
Organization Name:TELFAIR COUNTY COMMISSIONER OF ROADS & REVENUES
Other - Org Name:TELFAIR COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COUNTY CLERK
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:JM
Authorized Official - Last Name:LIVINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-868-5688
Mailing Address - Street 1:91 TELFAIR AVENUE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MCRAE
Mailing Address - State:GA
Mailing Address - Zip Code:31055
Mailing Address - Country:US
Mailing Address - Phone:229-868-5672
Mailing Address - Fax:229-868-6449
Practice Address - Street 1:274 E WILLOW CREEK LANE
Practice Address - Street 2:
Practice Address - City:MCRAE
Practice Address - State:GA
Practice Address - Zip Code:31055
Practice Address - Country:US
Practice Address - Phone:229-868-5672
Practice Address - Fax:229-868-6449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA134013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA590001693OtherRAILROAD MEDICARE
GA000259168AMedicaid
GA300036451AMedicaid
GA000259168AMedicaid