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General NPI Number Information
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NPI Number | 1699733832
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Entity Type | Organization
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Legal Business Name | JESUP EMERGENCY SERVICES, LLC
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 865 S 1ST ST
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City | JESUP
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State | GA
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Zip | 31545-0210
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Country | US
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Telephone | 912-427-6811
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 532855
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City | ATLANTA
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State | GA
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Zip | 30353-2855
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Country | US
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Telephone | 904-805-1300
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Fax | 904-805-1302
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Authorized Official
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Title or Position | CHAIRMAN/PRESIDENT/CEO
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Name | MR. ROBERT J BUNKER
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Credential |
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Telephone | 904-805-1300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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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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