Organization
CLARK EMS AMBULANCE SERVICE
Active
Other names
Clark Ambulance Service
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SAMUEL T CLARK OWNER (PRESIDENT)
(770) 445-5008
Entity
Organization
Contact information
Practice address
117A COMMERCE DR, DALLAS, GA 30132
(770) 445-2151
(770) 943-2855
Mailing address
PO BOX 1789, DALLAS, GA 30132
(770) 445-5008
(770) 943-2855
Taxonomy
Speciality
Code
Description
License number
State
146L00000X
Paramedic
Primary
11006
GA
146M00000X
Intermediate Emergency Medical Technician
11006
GA
146N00000X
Basic Emergency Medical Technician
11006
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00311165A
—
GA
01
—
590014898
RAILROAD MEDICARE
GA
Enumeration date
10/05/2006
Last updated
02/01/2013
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