Healthcare Provider Details

I. General information

NPI: 1851569560
Provider Name (Legal Business Name): GEORGIA EM-I MEDICAL SERVICES. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ALLEN MEMORIAL DR
BREMEN GA
30110-2012
US

IV. Provider business mailing address

PO BOX 781326
PHILADELPHIA PA
19178-1326
US

V. Phone/Fax

Practice location:
  • Phone: 954-939-5000
  • Fax: 877-250-6889
Mailing address:
  • Phone: 954-939-5000
  • Fax: 877-250-6889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER KENNEDY
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 207-807-9009