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General NPI Number Information
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NPI Number | 1952834962
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Entity Type | Organization
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Legal Business Name | SIGNATURE AMBULANCE AT STATESBORO LLC
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Dates
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Enumeration Date | 04/06/2017
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Last Update Date | 08/22/2022
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Provider Practice Location Address
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Address Line | 12148 US HIGHWAY 301 S
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City | STATESBORO
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State | GA
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Zip | 30458-3210
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Country | US
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Telephone | 912-259-9911
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Fax | 912-225-3087
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Provider Business Mailing Address
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Address Line | 12148 US HIGHWAY 301 S
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City | STATESBORO
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State | GA
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Zip | 30458-3210
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Country | US
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Telephone | 912-259-9911
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Fax | 912-225-3087
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. DOUGLAS RODNEY SOMMERS
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Credential | MD
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Telephone | 912-259-9911
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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 | AMB2017005
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License Number State | GA
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