Provider Demographics
NPI:1871665174
Name:WORTH COUNTY COMMISSIONER OF ROADS
Entity Type:Organization
Organization Name:WORTH COUNTY COMMISSIONER OF ROADS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:SALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-776-8223
Mailing Address - Street 1:201 N MAIN ST STE 30
Mailing Address - Street 2:
Mailing Address - City:SYLVESTER
Mailing Address - State:GA
Mailing Address - Zip Code:31791-3102
Mailing Address - Country:US
Mailing Address - Phone:229-776-8223
Mailing Address - Fax:229-776-8227
Practice Address - Street 1:807 S ISABELLA ST
Practice Address - Street 2:
Practice Address - City:SYLVESTER
Practice Address - State:GA
Practice Address - Zip Code:31791-7554
Practice Address - Country:US
Practice Address - Phone:229-776-8223
Practice Address - Fax:229-776-8227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA159-013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000233648AMedicaid
GA000233648AMedicaid