Organization
WAYNESBORO EMERGENCY SERVICES II, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT J BUNKER (CHAIRMAN/PRESIDENT/CEO)
(904) 805-1300
Entity
Organization
Contact information
Practice address
103 JV MANGUBAT DR, WAYNESBORO, TN 38485-2440
(931) 722-5411
(904) 805-1302
Mailing address
PO BOX 534114, ATLANTA, GA 30353-4114
(904) 805-1300
(904) 805-1302
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
154004300
DEPT OF LABOR
TN
05
—
3727708
—
TN
01
—
DC2765
RAIL ROAD MEDICARE
TN
Enumeration date
05/05/2006
Last updated
07/23/2008
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