Provider Demographics
NPI:1831536341
Name:SUPREME INTERNAL MEDICINE, P.C.
Entity type:Organization
Organization Name:SUPREME INTERNAL MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HAMILTON
Authorized Official - Middle Name:O
Authorized Official - Last Name:EMOKPAE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-243-9080
Mailing Address - Street 1:1207 MERCHANT WAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458
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:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA68726261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care