Healthcare Provider Details

I. General information

NPI: 1477796183
Provider Name (Legal Business Name): SHERIDAN EMERGENCY PHYSICIAN SERVICES OF GEORGIA,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 04/26/2013
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 452018
SUNRISE FL
33345-2018
US

V. Phone/Fax

Practice location:
  • Phone: 229-333-1000
  • Fax:
Mailing address:
  • Phone: 954-838-2371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: PAUL A. ANDRULONIS
Title or Position: PRESIDENT
Credential: MD
Phone: 954-838-2371