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Organization

CLARK AMBULANCE SERVICE, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. SAMUEL THOMAS CLARK (CEO/OWNER)
(770) 445-5008
Entity
Organization

Contact information

Practice address
117A COMMERCE DR, DALLAS, GA 30132-5025
(770) 445-2151
(770) 505-7273
Mailing address
PO BOX 1789, DALLAS, GA 30132-0031
(770) 445-5008
(770) 505-7273

Taxonomy

Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
110-06
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00311165A
GA
Enumeration date
01/19/2006
Last updated
04/17/2008
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