Provider Demographics
NPI:1851958607
Name:SOUTHLAND DODGE EMERGENCY MEDICAL SERVICES, LLC
Entity Type:Organization
Organization Name:SOUTHLAND DODGE EMERGENCY MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-236-0831
Mailing Address - Street 1:PO BOX 1276
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31799-1276
Mailing Address - Country:US
Mailing Address - Phone:229-236-0831
Mailing Address - Fax:229-236-0871
Practice Address - Street 1:901 GRIFFIN AVE
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-6720
Practice Address - Country:US
Practice Address - Phone:478-448-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-28
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty