Adventist Health System Georgia, Inc.
Organization Active NPI Land Ambulance · Chatsworth, GA
NPI 1669867487 · NPPES record last updated Feb 21, 2023
Key facts
- NPI
- 1669867487
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- License
- 0105125 (GA)
- Legal business name
- ADVENTIST HEALTH SYSTEM GEORGIA, INC.
- Practice address
- 707 Old Dalton Ellijay Rd
Chatsworth, GA 30705-2029 - Phone
- (706) 517-4564
- Fax
- (706) 517-2076
- NPI assigned
- Mar 30, 2015
- Organization subpart
- No
Authorized official
- Name
- Christopher Self
- Title
- President/Ceo
- Phone
- (706) 879-4710
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20151118000434 | GA | Part B Supplier - Ambulance Service Supplier | 0840251336 | Practice locations: Chatsworth, GA |
National Provider Directory
- Tax ID family
- Adairsville Family Med
Locations
104 Hospital Dr
Chatsworth, GA 30705
Phone (706) 517-2098
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | 0105125 | GA | Yes |
Addresses
Primary practice location
707 Old Dalton Ellijay Rd
Chatsworth, GA 30705-2029
Mailing address
707 Old Dalton Ellijay Rd
Chatsworth, GA 30705-2029
Phone (706) 517-4564
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00001383B | Medicaid | GA |
Other names
- AdventHealth Murray EMS
- Murray Medical Center
Other providers in Chatsworth, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 21, 2023. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.