# LIFE STAT EMS

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

## Provider details

- **NPI number:** 1942962048
- **Authorized official:** MICHAEL L WATERS (BILLING MANAGER)
- **Authorized official phone:** (770) 490-3911

## Contact information

- **Practice address:** 3551 BALL GROUND HWY, CANTON, GA 30114-7411
- **Practice address phone:** (404) 987-6278
- **Practice address fax:** (678) 807-2631
- **Mailing address:** PO BOX 4636, CANTON, GA 30114-0019
- **Mailing address phone:** (404) 987-6278
- **Mailing address fax:** (678) 807-2631

## Taxonomy

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

## Other

- **Enumeration date:** 10/06/2021
- **Last updated:** 01/20/2022