Provider Demographics
NPI:1790880474
Name:BOARD OF COMMISSIONERS OF FAYETTE COUNTY
Entity Type:Organization
Organization Name:BOARD OF COMMISSIONERS OF FAYETTE COUNTY
Other - Org Name:FAYETTE COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS CAPTAIN
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-305-5173
Mailing Address - Street 1:PO BOX 9150
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-9150
Mailing Address - Country:US
Mailing Address - Phone:270-744-9600
Mailing Address - Fax:270-744-8642
Practice Address - Street 1:140 STONEWALL AVE W
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1520
Practice Address - Country:US
Practice Address - Phone:770-305-5414
Practice Address - Fax:770-305-5190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000002648AMedicaid
GA85035559AAOtherMEDICARE PTAN