Healthcare Provider Details

I. General information

NPI: 1447701065
Provider Name (Legal Business Name): NES OF SHELBY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N PATTERSON ST
VALDOSTA GA
31602-1735
US

IV. Provider business mailing address

PO BOX 636482
CINCINNATI OH
45263-6482
US

V. Phone/Fax

Practice location:
  • Phone: 229-333-1000
  • Fax:
Mailing address:
  • Phone: 800-377-8721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER MOORE
Title or Position: CEO
Credential:
Phone: 415-435-4591