Provider Demographics
NPI:1255768149
Name:PALMS SOUTH LLC
Entity type:Organization
Organization Name:PALMS SOUTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAYSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-510-4786
Mailing Address - Street 1:PO BOX 843
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-0843
Mailing Address - Country:US
Mailing Address - Phone:404-510-4786
Mailing Address - Fax:
Practice Address - Street 1:108 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-4616
Practice Address - Country:US
Practice Address - Phone:404-510-4786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PALMS MEDICAL TRANSPORT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-09
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport