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NPI Code Detail

MEDICARE: SOUTHLAND CHATUGE EMERGENCY MEDICAL SERVICES, LLC

MEDICARE: SOUTHLAND CHATUGE EMERGENCY MEDICAL SERVICES, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician

General Provider Information

NPI Number : 1881127942
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHLAND CHATUGE EMERGENCY MEDICAL SERVICES, LLC
Provider Business Mailing Address
First Line : PO BOX 1276
Second Line :
City : THOMASVILLE
State : GA
Zip : 31799-1276
Country : US
Telephone Number : 229-236-0831
Fax Number : 229-236-0871
Provider Business Practice Location Address
First Line : 110 S MAIN ST
Second Line :
City : HIAWASSEE
State : GA
Zip : 30546-3408
Country : US
Telephone Number : 229-236-0831
Fax Number : 229-236-0871
Authorized Official
Title or Position : CFO
Name : STEPHANIE FLETCHER
Credential :
Telephone Number : 229-236-0831
Provider Enumeration Date : 04/06/2017
Last Update Date : 04/06/2017

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Directions to “SOUTHLAND CHATUGE EMERGENCY MEDICAL SERVICES, LLC ” Practice Location

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