Organization
DEEP SOUTH AMBULANCE SERVICE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN WESLEY PRUITT SR. (OWNER)
(229) 482-2899
Entity
Organization
Contact information
Practice address
37 PEACHTREE STREET, LAKELAND, GA 31635-0067
(229) 482-2899
Mailing address
PO BOX 67, 37 PEACHTREE ST, LAKELAND, GA 31635-0067
(229) 482-2899
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
086-02
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00432528A
—
GA
Enumeration date
01/10/2007
Last updated
01/15/2013
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