# PEACH STATE EMS, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184037616
- **Authorized official:** MR. DEVIN RAY STANCLIFF PARAMEDIC (OWNER)
- **Authorized official phone:** (678) 828-1250

## Contact information

- **Practice address:** 122 AMY INDUSTRIAL LN, HOSCHTON, GA 30548-2469
- **Practice address phone:** (888) 838-1391
- **Practice address fax:** (888) 391-8501
- **Mailing address:** PO BOX 545, BRASELTON, GA 30517-0010
- **Mailing address phone:** (888) 838-1391
- **Mailing address fax:** (888) 391-8501

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 078-04 | GA | Yes |

## Other

- **Enumeration date:** 06/02/2014
- **Last updated:** 06/05/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 078-04 | GA STATE EMS LICENSE NUMBER | GA |