Provider Demographics
NPI:1508886912
Name:GEORGIA EMERGENCY DEPARTMENT SERVICES, P.C.
Entity Type:Organization
Organization Name:GEORGIA EMERGENCY DEPARTMENT SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGIA EMERGENCY DE
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGIA EMERGENCY DEPARTMENT SERVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-294-0714
Mailing Address - Street 1:PO BOX 3387
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-3387
Mailing Address - Country:US
Mailing Address - Phone:866-863-6635
Mailing Address - Fax:855-269-9731
Practice Address - Street 1:743 SPRING ST NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3715
Practice Address - Country:US
Practice Address - Phone:770-536-2146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACH6759OtherRAILROAD MEDICARE
GACH6759OtherRAILROAD MEDICARE