# OKEFENOKEE EMS INC.

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

## Provider details

- **NPI number:** 1598834459
- **Authorized official:** MR. DEREK DANIEL MALLARD EMT-P (CEO)
- **Authorized official phone:** (912) 284-9111

## Contact information

- **Practice address:** 611 RIVERSIDE AVE, WAYCROSS, GA 31501-5322
- **Practice address phone:** (912) 284-9111
- **Mailing address:** PO BOX 1433, 611 RIVERSIDE AVE, WAYCROSS, GA 31502-1433
- **Mailing address phone:** (912) 284-9111

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 341600000X | Ambulance | 148-05 | GA | Yes |

## Other

- **Enumeration date:** 11/07/2006
- **Last updated:** 08/22/2020