Provider Demographics
NPI:1457764557
Name:SOUTHERN PRESTIGE EMS, LLC
Entity Type:Organization
Organization Name:SOUTHERN PRESTIGE EMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PARAMEDIC
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:MCDARIS
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:706-633-3819
Mailing Address - Street 1:613 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30560-3561
Mailing Address - Country:US
Mailing Address - Phone:706-633-0730
Mailing Address - Fax:
Practice Address - Street 1:613 LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:GA
Practice Address - Zip Code:30560-3561
Practice Address - Country:US
Practice Address - Phone:706-633-0730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport