Organization
GEORGIA MEDPORT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ZACHARY WILLIAMS NIX (CO-OWNER)
(770) 535-2601
Entity
Organization
Contact information
Practice address
1002 CHESTNUT ST SE, SUITE A, GAINESVILLE, GA 30501-6909
(770) 535-2601
(770) 535-2602
Mailing address
PO BOX 2306, GAINESVILLE, GA 30503-2306
(770) 535-2601
(770) 535-2602
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
069-19
GA
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003108574A
—
GA
01
—
202G593924
MEDICARE
GA
Enumeration date
03/13/2009
Last updated
05/29/2012
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