# DEEP SOUTH AMBULANCE SERVICE, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073662805
- **Authorized official:** MR. JOHN WESLEY PRUITT SR. (OWNER)
- **Authorized official phone:** (229) 482-2899

## Contact information

- **Practice address:** 37 PEACHTREE STREET, LAKELAND, GA 31635-0067
- **Practice address phone:** (229) 482-2899
- **Mailing address:** PO BOX 67, 37 PEACHTREE ST, LAKELAND, GA 31635-0067
- **Mailing address phone:** (229) 482-2899

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 086-02 | GA | Yes |

## Other

- **Enumeration date:** 01/10/2007
- **Last updated:** 01/15/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00432528A | — | GA |