Ga Peach Medical Transportation, LLC

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

Legal business name

GA PEACH MEDICAL TRANSPORTATION, LLC

Practice address

5023 Highway 85
Forest Park, GA 30297

Phone

(678) 705-8076

Fax

(678) 705-8079

NPI assigned

Jul 26, 2018

Last updated

Jul 26, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dennis Tyrone MiddlebrooksNPI 1669854519

Title

Ceo

Phone

(678) 705-8076

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 1

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.

• Dennis Middlebrooks

  • Paramedic
  • Decatur, GA
  • NPI 1669854519
  NPD Authorized official

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

{
    "created_epoch": "1532563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532563200000",
    "number": "1548747173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5023 GA HIGHWAY 85",
            "city": "FOREST PARK",
            "state": "GA",
            "postal_code": "302972431",
            "telephone_number": "678-705-8076",
            "fax_number": "678-705-8079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5023 HIGHWAY 85",
            "city": "FOREST PARK",
            "state": "GA",
            "postal_code": "30297",
            "telephone_number": "678-705-8076",
            "fax_number": "678-705-8079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GA PEACH MEDICAL TRANSPORTATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-26",
        "last_updated": "2018-07-26",
        "status": "A",
        "authorized_official_last_name": "MIDDLEBROOKS",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "TYRONE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "678-705-8076"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Land Ambulance in Forest Park, GA
• Providers in Forest Park, GA by specialty
• Land Ambulance in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2018; 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.