Healthcare Provider Details

I. General information

NPI: 1225080062
Provider Name (Legal Business Name): GEORGIA EMERGENCY CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 RED BUD RD NE
CALHOUN GA
30701-6000
US

IV. Provider business mailing address

P O BOX 635232
CINCINNATI OH
45263
US

V. Phone/Fax

Practice location:
  • Phone: 706-602-7800
  • Fax:
Mailing address:
  • Phone: 865-985-7212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. TODD HOLD
Title or Position: SECRETARY
Credential: M.D.
Phone: 706-629-2895