Provider Demographics
NPI:1487254660
Name:SOUTH GA AMBULANCE LLC
Entity type:Organization
Organization Name:SOUTH GA AMBULANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:YAWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-315-8292
Mailing Address - Street 1:855 W GOLDEN ISLES HWY
Mailing Address - Street 2:
Mailing Address - City:MC RAE HELENA
Mailing Address - State:GA
Mailing Address - Zip Code:31037-3914
Mailing Address - Country:US
Mailing Address - Phone:229-315-8292
Mailing Address - Fax:
Practice Address - Street 1:855 W GOLDEN ISLES HWY
Practice Address - Street 2:
Practice Address - City:MC RAE HELENA
Practice Address - State:GA
Practice Address - Zip Code:31037-3914
Practice Address - Country:US
Practice Address - Phone:229-315-8292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport