Provider Demographics
NPI:1184964587
Name:MEDEX OF GEORGIA INC
Entity type:Organization
Organization Name:MEDEX OF GEORGIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:KIRKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-737-0094
Mailing Address - Street 1:101 BELLAMY PL
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-4458
Mailing Address - Country:US
Mailing Address - Phone:678-565-6339
Mailing Address - Fax:678-565-6331
Practice Address - Street 1:101 BELLAMY PL
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-4458
Practice Address - Country:US
Practice Address - Phone:678-565-6339
Practice Address - Fax:678-565-6331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA075-113416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1184964587Medicare PIN