Provider Demographics
NPI:1265087779
Name:CHAMPION EMS
Entity type:Organization
Organization Name:CHAMPION EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARELIOUS
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-744-9157
Mailing Address - Street 1:6722 HIGHWAY 85 STE 5
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2373
Mailing Address - Country:US
Mailing Address - Phone:770-744-9157
Mailing Address - Fax:
Practice Address - Street 1:6722 HIGHWAY 85 STE 5
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2373
Practice Address - Country:US
Practice Address - Phone:770-744-9157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, IntermediateGroup - Multi-Specialty