Provider Demographics
NPI:1063825842
Name:AMELIA MEDICAL SERVICES, LLC
Entity Type:Organization
Organization Name:AMELIA MEDICAL SERVICES, LLC
Other - Org Name:AMELIA MEDICAL CARE, FOLKSTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATRICIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-583-3233
Mailing Address - Street 1:3435 SECOND ST S
Mailing Address - Street 2:
Mailing Address - City:FOLKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:31537-8447
Mailing Address - Country:US
Mailing Address - Phone:912-496-0041
Mailing Address - Fax:
Practice Address - Street 1:3435 SECOND ST S
Practice Address - Street 2:
Practice Address - City:FOLKSTON
Practice Address - State:GA
Practice Address - Zip Code:31537-8447
Practice Address - Country:US
Practice Address - Phone:912-496-0041
Practice Address - Fax:912-496-0053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA31289207Q00000X
GA261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty