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General NPI Number Information
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NPI Number | 1285780577
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Entity Type | Organization
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Legal Business Name | SOUTHERN EMS, INC
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Dates
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Enumeration Date | 01/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1395 SOUTHLAKE PKWY SUITE D
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City | MORROW
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State | GA
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Zip | 30260-2337
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Country | US
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Telephone | 404-768-1223
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 82451
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City | HAPEVILLE
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State | GA
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Zip | 30354-0451
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Country | US
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Telephone | 404-768-1223
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JONATHAN BALLESTEROS
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Credential | PARAMEDIC
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Telephone | 404-768-1223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 060-34
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License Number State | GA
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