Dooly County Commissioner of Roads and Revenues
Organization Active NPI Land Ambulance · Vienna, GA
NPI 1154401768 · NPPES record last updated Jun 30, 2015
Key facts
- NPI
- 1154401768
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- License
- 046-01 (GA)
- Legal business name
- DOOLY COUNTY COMMISSIONER OF ROADS AND REVENUES
- Practice address
- 209 W Union St
Vienna, GA 31092-1094 - Phone
- (229) 268-7529
- Fax
- (229) 268-3751
- NPI assigned
- Oct 17, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Don E. Willford Jr.
- Title
- EMS Director
- Phone
- (229) 268-7529
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D2267228 | Dooly County EMS | Certificate of waiver | Aug 22, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110120000533 | GA | Part B Supplier - Ambulance Service Supplier | 6406035641 | Practice locations: Vienna, GA |
National Provider Directory
Locations
211 Garrett Dr
Vienna, GA 31092
Phone (229) 268-7529
209 W Union St
Vienna, GA 31092
Phone (229) 268-7529
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulance | 341600000X | 046-01 | GA | |
| Land Ambulance | 3416L0300X | 046-01 | GA | Yes |
Addresses
Primary practice location
209 W Union St
Vienna, GA 31092-1094
Mailing address
209 W Union St
Vienna, GA 31092-1094
Phone (229) 268-7529
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00002571A | Medicaid | GA |
Other names
- Dooly County EMS
Other providers in Vienna, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 30, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.