Lifecare EMS of Georgia, LLC – Land Ambulance

Key facts

NPI: 1205112752
Entity type: Organization (NPI type 2)
Primary specialty: Land Ambulance 3416L0300X
Legal business name: LIFECARE EMS OF GEORGIA, LLC
Practice address: 363 Baldwin Rd
Cornelia, GA 30531-5785
Phone: (706) 754-0295
Fax: (706) 245-6187
NPI assigned: Oct 28, 2011
Organization subpart: No

Authorized official

Name: Brian Haney
Title: Owner
Phone: (706) 245-0689

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Janis N Anthony-Wade, DO Family Medicine Physician · Gainesville, GA · NPI 1477587913

NPD (past)

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA number	Laboratory	Certificate	Expires
11D2231176	Lifecare EMS of Georgia, LLC 363 Baldwin Road, Cornelia, GA 30531	Certificate of waiver	Jul 29, 2027

Medicare participation

Medicare fee-for-service enrollment: Enrolled in GA

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20120207000362	GA	Part B Supplier - Ambulance Service Supplier	2062679871	Practice locations: Byron, GA; Cornelia, GA; Gray, GA; Midland, GA; Royston, GA; Valdosta, GA

National Provider Directory

Locations

102 Church St
Byron, GA 31008
Phone (478) 278-2463

363 Baldwin Rd
Cornelia, GA 30531
Phone (706) 754-0295

9249 Veterans Pkwy
Midland, GA 31820
Phone (706) 245-0689

224 Tony Jones St
Royston, GA 30662
Phone (706) 245-0689

1045 Bowersville St
Royston, GA 30662
Phone (706) 245-0689

1040 Bowersville St
Royston, GA 30662
Phone (706) 245-0689

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Land Ambulance	3416L0300X			Yes

Addresses

Primary practice location

363 Baldwin Rd
Cornelia, GA 30531-5785

Mailing address

PO Box 5860
Athens, GA 30604-5860
Phone (706) 245-0689

Other providers in Cornelia, GA

All providers in Cornelia, GA · Land Ambulance in Georgia

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 22, 2024. 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.

Verify at the official NPI Registry.