# GEORGIA MEDPORT LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1619118015
- **Authorized official:** MR. ZACHARY WILLIAMS NIX (CO-OWNER)
- **Authorized official phone:** (770) 535-2601

## Contact information

- **Practice address:** 1002 CHESTNUT ST SE, SUITE A, GAINESVILLE, GA 30501-6909
- **Practice address phone:** (770) 535-2601
- **Practice address fax:** (770) 535-2602
- **Mailing address:** PO BOX 2306, GAINESVILLE, GA 30503-2306
- **Mailing address phone:** (770) 535-2601
- **Mailing address fax:** (770) 535-2602

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 069-19 | GA | Yes |
| 343900000X | Non-emergency Medical Transport (VAN) | — | NULL | — |

## Other

- **Enumeration date:** 03/13/2009
- **Last updated:** 05/29/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 003108574A | — | GA |
| 01 | — | 202G593924 | MEDICARE | GA |