Provider Demographics
NPI:1104103506
Name:CHOICECARE AMBULANCE SERVICE
Entity type:Organization
Organization Name:CHOICECARE AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-697-3714
Mailing Address - Street 1:1205 BELLEVUE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-4155
Mailing Address - Country:US
Mailing Address - Phone:478-697-3714
Mailing Address - Fax:
Practice Address - Street 1:1205 BELLEVUE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-4155
Practice Address - Country:US
Practice Address - Phone:478-697-3714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport