Atkinson County Board of Commissioners
Organization Active NPI Land Ambulance · Pearson, GA
NPI 1689310732 · NPPES record last updated Jun 28, 2023
Key facts
- NPI
- 1689310732
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- Legal business name
- ATKINSON COUNTY BOARD OF COMMISSIONERS
- Practice address
- 24 Austin Ave, West
Pearson, GA 31642-3952 - Phone
- (912) 422-4602
- Fax
- (724) 243-4703
- NPI assigned
- May 11, 2022
- Organization subpart
- No
Authorized official
- Name
- Mitchell Lee Davis
- Title
- EMS Director
- Phone
- (912) 422-4602
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D2260497 | Atkinson County EMS | Certificate of waiver | May 18, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220630000792 | GA | Part B Supplier - Ambulance Service Supplier | 2062892581 | Practice locations: Pearson, GA |
National Provider Directory
Locations
24 Austin Ave W
Pearson, GA 31642
Phone (912) 422-3391
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | Yes |
Addresses
Primary practice location
24 Austin Ave, West
Pearson, GA 31642-3952
Mailing address
892 New Castle Rd
Slippery Rock, PA 16057-4228
Phone (800) 280-5974
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Q184240001 | Other | GA | MEDICARE |
Other names
- Atkinson County EMS
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | m.davis@atkinson-ga.org | Direct |
Other providers in Pearson, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 28, 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.
- 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.