Provider Demographics
NPI:1801912597
Name:FANNIN COUNTY BOARD OF COMMISSIONERS
Entity type:Organization
Organization Name:FANNIN COUNTY BOARD OF COMMISSIONERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMA EMS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-632-1958
Mailing Address - Street 1:20 STATION RIDGE
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-0058
Mailing Address - Country:US
Mailing Address - Phone:706-632-4755
Mailing Address - Fax:706-632-3818
Practice Address - Street 1:20 STATION RIDGE
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-0058
Practice Address - Country:US
Practice Address - Phone:706-632-4755
Practice Address - Fax:706-632-3818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055-033416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00237366AMedicaid
GA85047159AAMedicare PIN