Georgia Medport LLC

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

069-19 Issued in GA

Legal business name

GEORGIA MEDPORT LLC

Practice address

1002 Chestnut St SE
Suite a
Gainesville, GA 30501-6909

Phone

(770) 535-2601

Fax

(770) 535-2602

NPI assigned

Mar 13, 2009

Last updated

May 29, 2012By 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

Mr. Zachary Williams Nix

Title

Co-Owner

Phone

(770) 535-2601

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1236902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338249600000",
    "number": "1619118015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2306",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305032306",
            "telephone_number": "770-535-2601",
            "fax_number": "770-535-2602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 CHESTNUT ST SE",
            "address_2": "SUITE A",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305016909",
            "telephone_number": "770-535-2601",
            "fax_number": "770-535-2602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA MEDPORT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-13",
        "last_updated": "2012-05-29",
        "status": "A",
        "authorized_official_last_name": "NIX",
        "authorized_official_first_name": "ZACHARY",
        "authorized_official_middle_name": "WILLIAMS",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "770-535-2601",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "GA",
            "license": "069-19",
            "primary": true
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003108574A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "202G593924",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Georgia Heart Institute LLC
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• Georgia Ketamine Renew
• Georgia Mountain Commmunity Services
• Georgia Mountain Community Partners (Avita Community Partners)
• Georgia Mountain Community Services (Avita Community Partners)
• Georgia Mountain Community Services
• Georgia Mountains Community Services

• Land Ambulance in Gainesville, GA
• Providers in Gainesville, GA by specialty
• Land Ambulance in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2012; 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.