Provider Demographics
NPI:1750443941
Name:DECATUR COUNTY BOARD OF COMMISSIONERS
Entity Type:Organization
Organization Name:DECATUR COUNTY BOARD OF COMMISSIONERS
Other - Org Name:DECATUR COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPUTY EMS CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BATTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-248-3001
Mailing Address - Street 1:PO BOX 726
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39818-0726
Mailing Address - Country:US
Mailing Address - Phone:229-248-3001
Mailing Address - Fax:229-248-3003
Practice Address - Street 1:307 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39817-6898
Practice Address - Country:US
Practice Address - Phone:229-248-3001
Practice Address - Fax:229-248-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043-053416L0300X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA590002836OtherRAILROAD MEDICARE
GA000064325AMedicaid
GA164253OtherBCBS OF GA
GA000064325AMedicaid