NPIMap

Organization Active NPI

Clayton County Board of Commissioners

  • Land Ambulance
  • Jonesboro, GA
National Provider Identifier
1073683603
Registry record updated Feb 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Land AmbulanceTaxonomy code 3416L0300X
License
031-02 Issued in GA
Legal business name
CLAYTON COUNTY BOARD OF COMMISSIONERS
Practice address
112 Smith St
Jonesboro, GA 30236-3539
Phone
(770) 472-8149
Fax
(770) 472-8014
NPI assigned
Nov 9, 2006
Last updated
Feb 20, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Jeffrey E Turner
Title
Chairman of Board of Commissioners
Phone
(770) 472-8122

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Land Ambulance 3416L0300X 031-02 GA Primary

Addresses

Primary practice location

112 Smith St
Jonesboro, GA 30236-3539

Mailing address

112 Smith St
Jonesboro, GA 30236-3539
Phone (770) 472-8149

Other identifiers 2

IdentifierTypeStateIssuer
000080484AMedicaidGA
590603969OtherGARAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050202000725 GA Part B Supplier - Ambulance Service Supplier 2163473539 Practice locations: Jonesboro, GA; Riverdale, GA

National Provider Directory

National Provider Directory

Locations

112 Smith St
Jonesboro, GA 30236
Phone (770) 472-8149

7810 Highway 85
Riverdale, GA 30274
Phone (770) 473-3831

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361318400000",
    "number": "1073683603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 SMITH ST",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302363539",
            "telephone_number": "770-472-8149",
            "fax_number": "770-472-8014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 SMITH ST",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302363539",
            "telephone_number": "770-472-8149",
            "fax_number": "770-472-8014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLAYTON COUNTY BOARD OF COMMISSIONERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2013-02-20",
        "status": "A",
        "authorized_official_last_name": "TURNER",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CHAIRMAN OF BOARD OF COMMISSIONERS",
        "authorized_official_telephone_number": "770-472-8122",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "GA",
            "license": "031-02",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000080484A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "590603969",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jonesboro, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.