Healthcare Provider Details

I. General information

NPI: 1720292584
Provider Name (Legal Business Name): SOUTHLAND HEALTH SERVICES OF GEORGIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1548 HIGHWAY 5 SOUTH
ELLIJAY GA
30540
US

IV. Provider business mailing address

PO BOX 1497
VERNON AL
35592-1497
US

V. Phone/Fax

Practice location:
  • Phone: 706-273-7477
  • Fax: 706-273-7479
Mailing address:
  • Phone: 205-695-9800
  • Fax: 205-695-7677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number StateGA

VIII. Authorized Official

Name: LARRY LUNAN
Title or Position: CEO
Credential:
Phone: 423-247-9560