Provider Demographics
NPI:1962444141
Name:WHITE COUNTY BOARD OF COMMISSIONERS
Entity Type:Organization
Organization Name:WHITE COUNTY BOARD OF COMMISSIONERS
Other - Org Name:WHITE COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HERDENER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-219-9000
Mailing Address - Street 1:PO BOX 908894
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-0930
Mailing Address - Country:US
Mailing Address - Phone:770-219-0509
Mailing Address - Fax:770-219-0561
Practice Address - Street 1:1331 HELEN HWY
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:GA
Practice Address - Zip Code:30528-2834
Practice Address - Country:US
Practice Address - Phone:770-219-7657
Practice Address - Fax:770-219-0561
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHEAST GEORGIA MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-12
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00300451AMedicaid
GA00300451AMedicaid
GA85052459AAMedicare PIN