Provider Demographics
NPI:1396788097
Name:WILKES COUNTY BOARD OF COMMISSIONERS
Entity type:Organization
Organization Name:WILKES COUNTY BOARD OF COMMISSIONERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:BAGWELL
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:706-678-7837
Mailing Address - Street 1:105 MARSHALL STREET
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30673
Mailing Address - Country:US
Mailing Address - Phone:706-678-7837
Mailing Address - Fax:
Practice Address - Street 1:105 MARSHALL STREET
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:GA
Practice Address - Zip Code:30673
Practice Address - Country:US
Practice Address - Phone:706-678-7837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILKES COUNTY BOARD OF COMMISSIONERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-13
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA157-023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000426489AMedicaid
GA000426489AMedicaid