=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093636284
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMS TEAM OF GEORGIA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2026
-----------------------------------------------------
Last Update Date | 07/23/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3501 HANGAR DR
-----------------------------------------------------
City | VANDALIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45377-1056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-877-1235
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 189
-----------------------------------------------------
City | VANDALIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45377-0189
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-949-4611
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DERECK PRISTAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 937-949-4611
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------