Provider Demographics
NPI:1548763899
Name:SOUTH GEORGIA ER SERVICES, LLC
Entity Type:Organization
Organization Name:SOUTH GEORGIA ER SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTLEBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-545-5551
Mailing Address - Street 1:PO BOX 1067
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30459-1067
Mailing Address - Country:US
Mailing Address - Phone:912-764-2455
Mailing Address - Fax:912-764-7522
Practice Address - Street 1:340 EISENHOWER DR STE 1305
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-1607
Practice Address - Country:US
Practice Address - Phone:888-545-5551
Practice Address - Fax:912-764-7522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty