Provider Demographics
NPI:1992715908
Name:GREENE COUNTY BOARD OF COMMISSIONERS
Entity type:Organization
Organization Name:GREENE COUNTY BOARD OF COMMISSIONERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR EMS
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-454-7011
Mailing Address - Street 1:1034 SILVER RD STE 201
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-2183
Mailing Address - Country:US
Mailing Address - Phone:706-454-7011
Mailing Address - Fax:706-453-9270
Practice Address - Street 1:2070 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-2762
Practice Address - Country:US
Practice Address - Phone:706-454-7011
Practice Address - Fax:706-453-9270
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREENE COUNTY BOARD OF COMMISSIONERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-09
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA066-033416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000408361BMedicaid
GA000408361BMedicaid