Provider Demographics
NPI:1205932381
Name:SCHLEY COUNTY COMMISSIONER
Entity type:Organization
Organization Name:SCHLEY COUNTY COMMISSIONER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-942-3375
Mailing Address - Street 1:106 NORTH PECAN STREET
Mailing Address - Street 2:
Mailing Address - City:ELLAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31806
Mailing Address - Country:US
Mailing Address - Phone:229-942-3375
Mailing Address - Fax:229-937-5880
Practice Address - Street 1:106 NORTH PECAN STREET
Practice Address - Street 2:
Practice Address - City:ELLAVILLE
Practice Address - State:GA
Practice Address - Zip Code:31806
Practice Address - Country:US
Practice Address - Phone:229-942-3375
Practice Address - Fax:229-937-5880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12301341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000207611AMedicaid
GA85033859AAOtherMEDICARE PTAN