Healthcare Provider Details

I. General information

NPI: 1982910048
Provider Name (Legal Business Name): AMELIA MEDICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 HWY 40 E
KINGSLAND GA
31548-6507
US

IV. Provider business mailing address

1481 HWY 40 E
KINGSLAND GA
31548-6507
US

V. Phone/Fax

Practice location:
  • Phone: 912-729-2821
  • Fax: 912-729-2823
Mailing address:
  • Phone: 912-729-2821
  • Fax: 912-729-2823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number031289
License Number StateGA

VIII. Authorized Official

Name: DR. DANIEL J. MATRICIA
Title or Position: OWNER
Credential: D.O.
Phone: 912-729-2821