Provider Demographics
NPI:1659435303
Name:WILCOX COUNTY COMMISSIONER OF ROADS & REVENUES
Entity Type:Organization
Organization Name:WILCOX COUNTY COMMISSIONER OF ROADS & REVENUES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:FUTCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:292-457-0966
Mailing Address - Street 1:529 AMERICAN LEGION ROAD
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE
Mailing Address - State:GA
Mailing Address - Zip Code:31079
Mailing Address - Country:US
Mailing Address - Phone:229-365-7562
Mailing Address - Fax:229-365-7948
Practice Address - Street 1:529 AMERICAN LEGION ROAD
Practice Address - Street 2:
Practice Address - City:ROCHELLE
Practice Address - State:GA
Practice Address - Zip Code:31079
Practice Address - Country:US
Practice Address - Phone:229-365-7562
Practice Address - Fax:229-365-7948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA156023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00067724AMedicaid
GAN340761Medicaid
GA00067724AMedicaid
GA85035959AAMedicare PIN