Provider Demographics
NPI:1952834962
Name:SIGNATURE AMBULANCE AT STATESBORO LLC
Entity Type:Organization
Organization Name:SIGNATURE AMBULANCE AT STATESBORO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:RODNEY
Authorized Official - Last Name:SOMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-259-9911
Mailing Address - Street 1:12148 US HIGHWAY 301 S
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-3210
Mailing Address - Country:US
Mailing Address - Phone:912-259-9911
Mailing Address - Fax:912-225-3087
Practice Address - Street 1:12148 US HIGHWAY 301 S
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-3210
Practice Address - Country:US
Practice Address - Phone:912-259-9911
Practice Address - Fax:912-225-3087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-06
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAMB20170053416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport