Provider Demographics
NPI:1790885010
Name:CITY OF HAPEVILLE
Entity Type:Organization
Organization Name:CITY OF HAPEVILLE
Other - Org Name:CITY OF HAPEVILLE FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-669-2141
Mailing Address - Street 1:PO BOX 82311
Mailing Address - Street 2:
Mailing Address - City:HAPEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30354-0311
Mailing Address - Country:US
Mailing Address - Phone:404-669-2141
Mailing Address - Fax:
Practice Address - Street 1:3468 N FULTON AVE
Practice Address - Street 2:
Practice Address - City:HAPEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30354-1466
Practice Address - Country:US
Practice Address - Phone:404-669-2141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-223416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000428755AMedicaid
GA000428755AMedicaid