Provider Demographics
NPI:1851381156
Name:GLYNN COUNTY GEORGIA
Entity Type:Organization
Organization Name:GLYNN COUNTY GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY CHIEF OF ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-554-7779
Mailing Address - Street 1:PO BOX 22514
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-2514
Mailing Address - Country:US
Mailing Address - Phone:833-281-5447
Mailing Address - Fax:937-291-2971
Practice Address - Street 1:121 PUBLIC SAFETY BLVD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-8906
Practice Address - Country:US
Practice Address - Phone:912-554-7779
Practice Address - Fax:912-297-3695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA063-013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA590003739OtherMEDICARE RAILROAD
GA000002703AMedicaid