Provider Demographics
NPI:1982910048
Name:AMELIA MEDICAL SERVICES, LLC
Entity Type:Organization
Organization Name:AMELIA MEDICAL SERVICES, LLC
Other - Org Name:AMELIA MEDICAL CARE, KINGSLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MATRICIA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:912-729-2821
Mailing Address - Street 1:1481 HWY 40 E
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-6507
Mailing Address - Country:US
Mailing Address - Phone:912-729-2821
Mailing Address - Fax:912-729-2823
Practice Address - Street 1:1481 HWY 40 E
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-6507
Practice Address - Country:US
Practice Address - Phone:912-729-2821
Practice Address - Fax:912-729-2823
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMELIA MEDICAL SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031289261QP2300X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA031289OtherGA MEDICAL LICENSE
GA1912972530OtherNPI - MATRICIA
GA1912972530OtherNPI - MATRICIA
BM1527211OtherDEA
BM1527211OtherDEA