# WAYNE COUNTY AMBULANCE SERVICE

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

## Provider details

- **NPI number:** 1790846665
- **Authorized official:** MR. RICHARD BLAKE JOHNSON (DIRECTOR)
- **Authorized official phone:** (912) 427-5999

## Contact information

- **Practice address:** 477 W BAY ST, JESUP, GA 31545-1223
- **Practice address phone:** (912) 427-5999
- **Practice address fax:** (912) 427-5906
- **Mailing address:** PO BOX 270, JESUP, GA 31598-0270
- **Mailing address phone:** (912) 427-5999
- **Mailing address fax:** (912) 427-5906

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 151-01 | GA | Yes |

## Other

- **Enumeration date:** 12/13/2006
- **Last updated:** 01/22/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 000348444A | — | GA |
| 01 | — | 590008778 | RAILROAD MEDICARE | GA |