# SIGNATURE AMBULANCE AT STATESBORO LLC

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

## Provider details

- **NPI number:** 1952834962
- **Authorized official:** DR. DOUGLAS RODNEY SOMMERS MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (912) 259-9911

## Contact information

- **Practice address:** 12148 US HIGHWAY 301 S, STATESBORO, GA 30458-3210
- **Practice address phone:** (912) 259-9911
- **Practice address fax:** (912) 225-3087
- **Mailing address:** 12148 US HIGHWAY 301 S, STATESBORO, GA 30458-3210
- **Mailing address phone:** (912) 259-9911
- **Mailing address fax:** (912) 225-3087

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | AMB2017005 | GA | Yes |

## Other

- **Enumeration date:** 04/06/2017
- **Last updated:** 08/22/2022