Provider Demographics
NPI:1891130647
Name:SUPREME INTERNAL MEDICINE
Entity Type:Organization
Organization Name:SUPREME INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAMILTON
Authorized Official - Middle Name:
Authorized Official - Last Name:EMOKPAE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-243-9080
Mailing Address - Street 1:PO BOX 2380
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30459-2380
Mailing Address - Country:US
Mailing Address - Phone:912-243-9080
Mailing Address - Fax:912-243-9084
Practice Address - Street 1:1207 MERCHANT WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-0861
Practice Address - Country:US
Practice Address - Phone:912-243-9080
Practice Address - Fax:912-243-9084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty