# GA PEACH MEDICAL TRANSPORTATION, LLC

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

## Provider details

- **NPI number:** 1548747173
- **Authorized official:** DENNIS TYRONE MIDDLEBROOKS (CEO)
- **Authorized official phone:** (678) 705-8076

## Contact information

- **Practice address:** 5023 HIGHWAY 85, FOREST PARK, GA 30297
- **Practice address phone:** (678) 705-8076
- **Practice address fax:** (678) 705-8079
- **Mailing address:** 5023 GA HIGHWAY 85, FOREST PARK, GA 30297-2431
- **Mailing address phone:** (678) 705-8076
- **Mailing address fax:** (678) 705-8079

## Taxonomy

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

## Other

- **Enumeration date:** 07/26/2018
- **Last updated:** 07/26/2018