Healthcare Provider Details

I. General information

NPI: 1780080192
Provider Name (Legal Business Name): GEORGIA EM-I MEDICAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2014
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5126 HOSPITAL DR NE
COVINGTON GA
30014-2566
US

IV. Provider business mailing address

5565 CENTER VIEW DR STE 107
RALEIGH NC
27606-3563
US

V. Phone/Fax

Practice location:
  • Phone: 469-401-2386
  • Fax: 214-712-2444
Mailing address:
  • Phone: 469-613-8343
  • Fax: 877-411-5650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LISA KERR
Title or Position: ENROLLMENT
Credential: M.D.
Phone: 469-613-8343