Provider Demographics
NPI:1205112752
Name:LIFECARE EMS OF GEORGIA, LLC
Entity type:Organization
Organization Name:LIFECARE EMS OF GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-245-0689
Mailing Address - Street 1:PO BOX 5860
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30604-5860
Mailing Address - Country:US
Mailing Address - Phone:706-245-0689
Mailing Address - Fax:706-245-6187
Practice Address - Street 1:363 BALDWIN RD
Practice Address - Street 2:
Practice Address - City:CORNELIA
Practice Address - State:GA
Practice Address - Zip Code:30531-5785
Practice Address - Country:US
Practice Address - Phone:706-754-0295
Practice Address - Fax:706-245-6187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-28
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3416L0300X
GAPENDING3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport