Provider Demographics
NPI:1972608644
Name:DOUGHERTY COUNTY COMMISSIONER OF ROADS & REVENUES
Entity type:Organization
Organization Name:DOUGHERTY COUNTY COMMISSIONER OF ROADS & REVENUES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:SAM
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-439-7011
Mailing Address - Street 1:1436 PALMYRA RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1868
Mailing Address - Country:US
Mailing Address - Phone:229-439-7011
Mailing Address - Fax:229-439-4040
Practice Address - Street 1:1436 PALMYRA RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1868
Practice Address - Country:US
Practice Address - Phone:229-439-7011
Practice Address - Fax:229-439-4040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA04701341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA80112959AAOtherMEDICARE PTAN
GA00099206A3Medicaid