Healthcare Provider Details

I. General information

NPI: 1639561665
Provider Name (Legal Business Name): NATIONS EMS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2015
Last Update Date: 02/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2064 REX RD SUITE 4A
LAKE CITY GA
30260-3967
US

IV. Provider business mailing address

2064 REX RD SUITE 4A
LAKE CITY GA
30260-3967
US

V. Phone/Fax

Practice location:
  • Phone: 404-363-6624
  • Fax: 404-363-6621
Mailing address:
  • Phone: 404-363-6624
  • Fax: 404-363-6621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number031-29
License Number StateGA

VIII. Authorized Official

Name: ROGER GEORGE SR.
Title or Position: EMS DIRECTOR
Credential:
Phone: 478-737-8035