Provider Demographics
NPI:1154401768
Name:DOOLY COUNTY COMMISSIONER OF ROADS AND REVENUES
Entity type:Organization
Organization Name:DOOLY COUNTY COMMISSIONER OF ROADS AND REVENUES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILLFORD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:229-268-7529
Mailing Address - Street 1:209 W UNION ST
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:GA
Mailing Address - Zip Code:31092-1094
Mailing Address - Country:US
Mailing Address - Phone:229-268-7529
Mailing Address - Fax:229-268-3751
Practice Address - Street 1:209 W UNION ST
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:GA
Practice Address - Zip Code:31092-1094
Practice Address - Country:US
Practice Address - Phone:229-268-7529
Practice Address - Fax:229-268-3751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046-01341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00002571AMedicaid
GA59RCBMXMedicare ID - Type Unspecified