Provider Demographics
NPI:1942962048
Name:LIFE STAT EMS
Entity Type:Organization
Organization Name:LIFE STAT EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-490-3911
Mailing Address - Street 1:PO BOX 4636
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-0019
Mailing Address - Country:US
Mailing Address - Phone:404-987-6278
Mailing Address - Fax:678-807-2631
Practice Address - Street 1:3551 BALL GROUND HWY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-7411
Practice Address - Country:US
Practice Address - Phone:404-987-6278
Practice Address - Fax:678-807-2631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-06
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport