Provider Demographics
NPI:1851807119
Name:ANGEL WINGS MEDICAL TRANSPORT, LLC
Entity type:Organization
Organization Name:ANGEL WINGS MEDICAL TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-318-3181
Mailing Address - Street 1:426 N EXPRESSWAY STE D
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-2095
Mailing Address - Country:US
Mailing Address - Phone:770-318-3181
Mailing Address - Fax:770-228-2903
Practice Address - Street 1:426 N EXPRESSWAY STE D
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-2095
Practice Address - Country:US
Practice Address - Phone:770-318-3181
Practice Address - Fax:770-228-2903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-22
Last Update Date:2017-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport