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General NPI Number Information
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NPI Number | 1598926263
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Entity Type | Organization
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Legal Business Name | EMORY MEDICAL CORPORATION
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Dates
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Enumeration Date | 06/24/2008
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Last Update Date | 03/04/2020
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Provider Practice Location Address
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Address Line | 4812 W US HIGHWAY 90
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City | LAKE CITY
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State | FL
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Zip | 32055-5126
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Country | US
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Telephone | 386-466-1106
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Fax | 386-466-1821
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Provider Business Mailing Address
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Address Line | PO BOX 1646
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City | LAKE CITY
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State | FL
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Zip | 32056-1646
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Country | US
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Telephone | 386-466-1106
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Fax | 386-466-1821
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | CHANDLER MOHAN
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Credential | MD
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Telephone | 386-466-1106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 0101243179
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 0101243179
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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