Healthcare Provider Details

I. General information

NPI: 1659606994
Provider Name (Legal Business Name): GEORGIA EM-I MEDICAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2009
Last Update Date: 10/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 PALMYRA RD
ALBANY GA
31701-1528
US

IV. Provider business mailing address

PO BOX 37797
PHILADELPHIA PA
19101-5097
US

V. Phone/Fax

Practice location:
  • Phone: 229-434-2000
  • Fax:
Mailing address:
  • Phone: 727-507-3609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: GREGORY J. BYRNE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 727-507-3609