Provider Demographics
NPI:1376878223
Name:EMS
Entity Type:Organization
Organization Name:EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-907-5104
Mailing Address - Street 1:500 W LANIER AVE
Mailing Address - Street 2:STE 410
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7636
Mailing Address - Country:US
Mailing Address - Phone:678-817-6200
Mailing Address - Fax:770-719-5263
Practice Address - Street 1:500 W LANIER AVE
Practice Address - Street 2:STE 410
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7636
Practice Address - Country:US
Practice Address - Phone:678-817-6200
Practice Address - Fax:770-719-5263
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:E MEDICAL STAFFING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-10
Last Update Date:2009-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA434157984A251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA434157984AMedicaid