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General NPI Number Information
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NPI Number | 1194785170
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Entity Type | Organization
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Legal Business Name | EMERGENCY MEDICINE SOUTH LLC
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 12/12/2008
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Provider Practice Location Address
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Address Line | 2501 N PATTERSON ST
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City | VALDOSTA
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State | GA
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Zip | 31602
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Country | US
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Telephone | 229-333-1000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 402059
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City | ATLANTA
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State | GA
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Zip | 30384-2059
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Country | US
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Telephone | 229-333-1000
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Fax |
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | PAM KLEBOSITS
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Credential |
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Telephone | 229-259-4660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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