Provider Demographics
NPI:1215920459
Name:CAPITAL CITY AMBULANCE OF GEORGIA INC
Entity type:Organization
Organization Name:CAPITAL CITY AMBULANCE OF GEORGIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:ADKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-829-7771
Mailing Address - Street 1:2623 WASHINGTON ROAD E101
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904
Mailing Address - Country:US
Mailing Address - Phone:706-829-7771
Mailing Address - Fax:803-442-9024
Practice Address - Street 1:2623 WASHINGTON RD STE E101
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-5965
Practice Address - Country:US
Practice Address - Phone:706-829-7771
Practice Address - Fax:803-442-9024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA62191341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00230724OtherRAILROAD MEDICARE
GA585329322AMedicaid
SCAB0245Medicaid
GA59RCBNRMedicare ID - Type Unspecified