Provider Demographics
NPI:1457541690
Name:JENKINS COUNTY BOARD OF COMMISSIONERS
Entity Type:Organization
Organization Name:JENKINS COUNTY BOARD OF COMMISSIONERS
Other - Org Name:JENKINS COUNTY AMBULANCE SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-982-2563
Mailing Address - Street 1:PO BOX 797
Mailing Address - Street 2:
Mailing Address - City:MILLEN
Mailing Address - State:GA
Mailing Address - Zip Code:30442-0797
Mailing Address - Country:US
Mailing Address - Phone:478-982-2563
Mailing Address - Fax:478-982-4750
Practice Address - Street 1:611 E WINTHROPE AVE
Practice Address - Street 2:
Practice Address - City:MILLEN
Practice Address - State:GA
Practice Address - Zip Code:30442-1833
Practice Address - Country:US
Practice Address - Phone:478-982-2563
Practice Address - Fax:478-982-4750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA082013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10070315Medicaid
GA85030059AAOtherMEDICARE