Healthcare Provider Details

I. General information

NPI: 1063825842
Provider Name (Legal Business Name): AMELIA MEDICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 10/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 SECOND ST S
FOLKSTON GA
31537-8447
US

IV. Provider business mailing address

3435 SECOND ST S
FOLKSTON GA
31537-8447
US

V. Phone/Fax

Practice location:
  • Phone: 912-496-0041
  • Fax: 912-496-0053
Mailing address:
  • Phone: 912-496-0041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31289
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateGA

VIII. Authorized Official

Name: SUE MATRICIA
Title or Position: CHIEF OPERATIONS OFFICER
Credential:
Phone: 904-583-3233