Provider Demographics
NPI:1700112398
Name:SOUTHERN REGIONAL MOBILE HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:SOUTHERN REGIONAL MOBILE HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-423-3376
Mailing Address - Street 1:PO BOX 5224
Mailing Address - Street 2:
Mailing Address - City:FITZGERALD
Mailing Address - State:GA
Mailing Address - Zip Code:31750-5224
Mailing Address - Country:US
Mailing Address - Phone:866-776-4707
Mailing Address - Fax:229-423-3385
Practice Address - Street 1:808 S GRANT ST
Practice Address - Street 2:
Practice Address - City:FITZGERALD
Practice Address - State:GA
Practice Address - Zip Code:31750-3703
Practice Address - Country:US
Practice Address - Phone:229-423-3376
Practice Address - Fax:229-423-3385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA009-023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport