Provider Demographics
NPI:1952363301
Name:HENRY COUNTY COMMISSIONER OF ROADS AND REVENUES
Entity Type:Organization
Organization Name:HENRY COUNTY COMMISSIONER OF ROADS AND REVENUES
Other - Org Name:HENRY COUNTY BOARD OF COMMISSIONERS
Other - Org Type:Other Name
Authorized Official - Title/Position:AMBULANCE BILLING MGR
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-288-6688
Mailing Address - Street 1:110 S ZACK HINTON PKWY
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-3353
Mailing Address - Country:US
Mailing Address - Phone:770-288-6536
Mailing Address - Fax:770-288-6544
Practice Address - Street 1:110 S ZACK HINTON PKWY
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3353
Practice Address - Country:US
Practice Address - Phone:770-288-6536
Practice Address - Fax:770-288-6544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA075-033416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000110415AMedicaid
GA85035759AAMedicare ID - Type Unspecified