MEDICARE: PREMED MEDICAL SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1730625708
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMED MEDICAL SERVICES, INC.

Provider Business Mailing Address
First Line	:	8956 CRESTVIEW CIR
Second Line	:
City	:	UNION CITY
State	:	GA
Zip	:	30291-6071
Country	:	US
Telephone Number	:	770-883-1434
Fax Number	:

Provider Business Practice Location Address
First Line	:	8956 CRESTVIEW CIR
Second Line	:
City	:	UNION CITY
State	:	GA
Zip	:	30291-6071
Country	:	US
Telephone Number	:	770-883-1434
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	SHEILA TILLMAN
Credential	:
Telephone Number	:	770-883-1434

Provider Enumeration Date	:	01/13/2017
Last Update Date	:	01/13/2017

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