Healthcare Provider Details

I. General information

NPI: 1598528085
Provider Name (Legal Business Name): SOUTH EAST MEDICAL RESPONSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 CHERRYFIELD LN
SAVANNAH GA
31419-9095
US

IV. Provider business mailing address

154 CHERRYFIELD LN
SAVANNAH GA
31419-9095
US

V. Phone/Fax

Practice location:
  • Phone: 912-856-7115
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JOSHUA RUSSELL CARPENTER
Title or Position: EMT-B
Credential:
Phone: 912-856-7115