Healthcare Provider Details

I. General information

NPI: 1699113357
Provider Name (Legal Business Name): GEORGIA EM-I MEDICAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 06/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 OLD DALTON ELLIJAY RD
CHATSWORTH GA
30705-2029
US

IV. Provider business mailing address

PO BOX 37913
PHILADELPHIA PA
19101-0510
US

V. Phone/Fax

Practice location:
  • Phone: 706-517-2057
  • Fax: 706-517-3797
Mailing address:
  • Phone: 800-507-8874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GREGORY J BYRNE
Title or Position: PRESIDENT
Credential: MD
Phone: 800-507-8874