NPIMap

Organization Active NPI

Hospital Ambulance of Georgia, LLC

  • Land Ambulance
  • Riverdale, GA
National Provider Identifier
1184870594
Registry record updated Aug 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Land AmbulanceTaxonomy code 3416L0300X
License
031-21 Issued in GA
Legal business name
HOSPITAL AMBULANCE OF GEORGIA, LLC
Practice address
181B SW Upper Riverdale Rd
Riverdale, GA 30274-0000
Phone
(843) 229-1617
Fax
(770) 490-0038
NPI assigned
Aug 18, 2008
Last updated
Aug 18, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2008

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

Authorized official

Name
Mr. Jay Nettles
Title
Owner
Phone
(843) 229-1617

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Land Ambulance 3416L0300X 031-21 GA Primary

Addresses

Primary practice location

181B SW Upper Riverdale Rd
Riverdale, GA 30274-0000

Mailing address

PO Box 1117
Fayetteville, GA 30214-6117
Phone (770) 719-5337

National Provider Directory

National Provider Directory

Locations

181 Upper Riverdale Rd SW
#B
Riverdale, GA 30274
Phone (843) 229-1617

NPI Registry JSON

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

{
    "created_epoch": "1219017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219017600000",
    "number": "1184870594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1117",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302146117",
            "telephone_number": "770-719-5337",
            "fax_number": "770-907-1588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "181B SW UPPER RIVERDALE RD",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302740000",
            "telephone_number": "843-229-1617",
            "fax_number": "770-490-0038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPITAL AMBULANCE OF GEORGIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-18",
        "last_updated": "2008-08-18",
        "status": "A",
        "authorized_official_last_name": "NETTLES",
        "authorized_official_first_name": "JAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-229-1617",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "GA",
            "license": "031-21",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverdale, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.